Predictive value of difficult airway identifiers for intubation-related complications in the emergency department

Objectives The Airway Alert banner at our institution alerts physicians to patients with the potential for a difficult intubation. Difficult airway guidelines can reduce intubation complications in the operating room, but little research has been done in the emergency department (ED). We hypothesize that patients meeting criteria for the banner will have a more difficult intubation and increased complications. Methods Patients greater than 18 years old who presented to the ED for any complaint and required intubation were reviewed from January 2015 to January 2020 and divided into those meeting criteria for a difficult airway ("criteria cohort") and those who did not ("non-criteria cohort"). Past medical history and details of the intubation were collected. Results The mean number of attempts for intubation was 1.60 in the criteria cohort and 1.36 in the non-criteria cohort (P > .05). The mean grade of view was 1.73 and 1.39, respectively (P < .05). The average size of endotracheal tube was 7.50 and 7.74 in the criteria and non-criteria cohorts (P < .05). The use of adjuncts was 28.6% and 12.5%, respectively (P < .01). The average number of intubation attempts and complication rate did not differ significantly. Conclusions Intubations in patients meeting criteria for the banner are associated with a more difficult view, use of smaller endotracheal tube, and increased use of adjuncts, but not with a significantly higher rate of complications or attempts. Physicians should prepare with additional endotracheal tube sizes, adjuncts, and a plan for secondary strategies in these patients. Level of Evidence 2b.