Emergency airway management by resident physicians in Japan: an analysis of multicentre prospective observational study

Aim: To examine the success rates of emergency department airway management by resident physicians in Japan. Methods: We conducted an analysis of a multicentre prospective registry (Japanese Emergency Airway Network Registry) of 13 academic and community emergency departments in Japan. We included all patients who underwent emergency intubation performed by postgraduate year 1 to 5 transitional or emergency medicine residents (resident physicians) between April 2010 and August 2012. Outcome measures were success rates by the first intubator, and by rescue intubator, according to the level of training. Results: We recorded 4,094 intubations (capture rate, 96%); 2,800 attempts (2,800/4,094; 68%; 95% confidence interval (CI), 67%-70%) were initially performed by resident physicians. Overall success rate on the first attempt was 63% (1,767/2,789; 95% CI, 61%-64%); the rate improved over the first 3 years of training before reaching a plateau (P-trend < 0.001). Success rate by the first intubator was 78% (2,185/2,800; 95% CI, 76%-79%); the rate steadily improved as level of training increased (P-trend < 0.001). Of 597 failed intubation attempts by the first intubator, 41% (247/597; 95% CI, 37%-45%) of rescue attempts were performed by resident physicians. Success rate on the first rescue attempt was 76% (187/247; 95% CI, 70%-81%), and success rate by first rescue intubator was 89% (220/247; 95% CI, 85%-93%). These rates on rescue attempts steadily improved as level of training increased (both P-trend < 0.001). Intubations were ultimately successful in 2,778 encounters (99.6%). Conclusion: In this multicentre study characterizing emergency airway management across Japan, we observed that emergency department intubations were primarily managed by resident physicians with acceptably high success rates overall.