Emergency Department Intubations in Patients With Angioedema: A Report from the National Emergency Airway Registry

Background: Angioedema, a localized swelling of subcutaneous and submucosal tissues, may involve the upper airway. A subset of patients presenting for emergent evaluation of angioedema will require intubation. Little is known about airway management practices in patients with angioedema requiring intubation in the emergency department (ED). Objective: To describe airway management practices in patients intubated for angioedema in the ED. Methods: We analyzed data from the National Emergency Airway Registry. All patients with an intubation attempt for angioedema between January 1, 2016 and December 31, 2018 were included. We report univariate descriptive data as proportions with cluster-adjusted 95% confidence intervals. Results: Of 19,071 patient encounters, intubation was performed for angioedema in 98 (0.5%). First-attempt success was achieved in 81 %, with emergency physicians performing the procedure in 94% of encounters. The most common device used was a flexible endoscope (49%), and 42% of attempts were via a nasal route. Pharmacologic methods included sedation with paralysis (61%), topical anesthesia with or without sedation (13% and 13 %, respectively), and sedation only (10%). Among 19 (19%) patients requiring additional attempts, intubation was achieved on second at- tempt in 10 (53 %). The most common adverse events were hypotension (13 %) and hypoxemia (12 %). Cricothyrotomy occurred in 2 patients (2 %). No deaths were observed. Conclusions: Angioedema was a rare indication for intubation in the ED setting. Emergency physicians achieved first-attempt success in 81 % of encounters and used a broad range of intubation devices and methods, including flexible endoscopic techniques. Cricothyrotomy was rare, and no ED deaths were reported. (C) 2021 Elsevier Inc. (C) 2021 Elsevier Inc. All rights reserved.