Evaluation of a Difficult Airway Educational Intervention on Residents’ Performance of Endotracheal Intubation in the Emergency Department

Aims: To evaluate the effectiveness of a brief educational intervention and a predictive difficult airway (DA) checklist on performance of emergency endotracheal intubation by residents.
Place and Duration of Study: The Emergency Department (ED) of Interim Louisiana State University Public Hospital, the level one trauma center in New Orleans, from September 2006 to June 2010.
Methodology: We performed a retrospective chart review of patients intubated in the ED during the study period. Demographic, physiologic and procedural data had been previously recorded on a worksheet immediately following each intubation. In July 2008, residents received a lecture on management strategies for the DA and participated in simulation exercises based on DA scenarios. A detailed checklist of DA predictors was added to the standard intubation form, and completed by the resident prior to each intubation. Procedural outcomes were compared for number of attempts, time to successful intubation, faculty involvement and use of adjunct devices for the pre-and post-intervention periods using generalized estimating equations and z statistics.
Results: There were 266 intubations in the pre-intervention period and 373 in the post-intervention period. 50.3% of post-intervention intubations met criteria for DA. Time to successful intubation did not vary between the two groups (11.6 minutes pre; 10.8 post, P=0.30). There was no significant difference in the number of attempts (1.4 pre; 1.3 post, P =0.44) or faculty interventions (1.5 v. 3.75%) or the number of successful intubations that were assisted by adjuncts (P =0.22). Success on the second attempt was more likely if an adjunct was used (P =0.24).
Conclusion: A brief DA educational module and the application of a standard pre- intubation checklist resulted in few appreciable changes in EM resident intubations. Further research is needed to more clearly define the relationship between DA education and resident intubation performance.