Association of advanced age with intubation-related adverse events in the emergency department: a multicentre prospective observational study

Background While the older population accounts for an increasing proportion of emergency department (ED), little is known about intubation-related adverse events in this high-risk population. We sought to determine whether advanced age is associated with a higher risk of intubation-related adverse events in the ED. Methods This is an analysis of data from a prospective, 15-centre, observational study-the second Japanese Emergency Airway Network (JEAN-2) study. The current analysis included adult (aged >= 18 years) patients who underwent intubation in the ED between 2012 and 2018. The primary exposure was age (18-39, 40-64, 65-74, 75-84 and >= 85 years). The primary outcome was overall intubation-related adverse events during or immediately after an intubation. Adverse events were further categorised into major (hypotension, hypoxaemia, oesophageal intubation, cardiac arrest, dysrhythmia and death) and minor (endobronchial intubation, oesophageal intubation with early recognition, dental/lip trauma, airway trauma and regurgitation) adverse events. We constructed multivariable logistic regression models adjusting for seven potential confounders with generalised estimating equations that account for patients clustering within the ED. Results Among 9714 patients eligible for the analysis, 15% were aged >= 85 years, and 16% had adverse events. In the unadjusted models, advanced age was not significantly associated with the risk of overall adverse events. In the adjusted models, the association was significant (adjusted OR 1.41 in age >= 85 years (95% CI, 1.09 to 1.81) compared with age 18-39 years). Specifically, older patients had a significantly higher risk of major adverse events (adjusted OR in age >= 85 years 2.65 (95% CI, 1.78 to 3.94)), which was driven by the association of advanced age with an increased risk of hypotension (adjusted OR in >= 85 years, 5.69 (95% CI, 3.13 to 10.37)). By contrast, advanced age was not associated with minor adverse events. Conclusion Based on the data from a prospective multicentre study, advanced age was associated with higher risks of major adverse events.