RecruitingACTRN12613001052729

The Australia and New Zealand Emergency Department Airway Registry (ANZEDAR). A multi-centre observational study of the practice of intubation in the Emergency Department (ED)

Prospective, multicentre, observational study of all patients undergoing endotracheal intubation in the Emergency Department, to evaluate key metrics including indication for intubation, staff seniority, techniques, number of attempts at laryngoscopy required and the rate of intubation manoeuvres and complications.

Sponsor

Toby Fogg

Enrollment

2,500 participants

Start Date

Jul 1, 2013

Study Type

Observational

Conditions

Shock due to trauma Altered mental status not due to overdose Stroke/ICH Burns/Inhalation Neck or Facial Trauma Drowning Anaphylaxis Sepsis Respiratory Failure Cardiac Failure Cardiac Arrest GI Bleed Head Injury Traumatic Cardiac Arrest Overdose/Ingestion

Summary

Advanced airway management is an accepted core skill of Emergency Physicians in Australasia. Rapid Sequence INtubation (RSI) is, however, a high-risk procedure that has been shown to have an increased rate of severe complications – such as failed intubation, hypoxia, hypotension or surgical airway – when it takes place in the Emergency Department (ED) in comparison to the operating theatre. The recently published Fourth National Audit of Major Complications of Airway Management in the UK reviewed severe complications associated with airway management in the ED. The authors found that a large proportion of events occurred out of hours, without consultant supervision, or without the operators following standard airway management algorithms and “failing to plan for failure.” Several studies have been published that describe the performance of intubation in the EDs of North America, UK, Korea and Japan, but to date, only a single centre study has been published from an Australian ED. This study, carried out at the Royal North Shore Hospital, prompted significant changes in the practice of intubation in that ED, along with an increased educational focus on the subject, in order to improve clinical management. This current project is being led by Dr. Toby Fogg and Dr. John Vassiliadis from the Royal North Shore Hospital ED, as a collaborative research venture with other EDs across Australasia and the Emergency Care Institute in NSW. It is a surveillance study to acquire data on the practice of intubation in the ED in order to improve the quality of care associated with this procedure.

Eligibility

Sex: Both males and females

Inclusion Criteria1

All patients requiring endotracheal intubation in the ED

Exclusion Criteria1

None

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Interventions

We will record the indication for intubation, staff seniority, techniques (eg induction drugs or type of laryngoscope, bougie or stylet use), number of attempts at laryngoscopy required and the rate of intubation manoevres and complications. The entire process usually lasts only a few minutes, however complications are relevant if they occur within 10 minutes.