Table 3.
Multivariable associations of number of failed attempts before first rescue intubation with success rates
| Primary analysis | Sensitivity analysis | ||
|---|---|---|---|
| (No. of failed attempts as categorical variable) | (No. of failed attempts as dichotomous variable) | (No. of failed attempts as ordinal variable) | |
| Variables | OR (95% CI) | OR (95% CI) | OR (95% CI) |
| Primary exposure | |||
| Number of failed attempts | |||
| (categorical variable) | |||
| 1 | 1 [reference] | 1 [reference] | 1 [reference] |
| 2 | 0.56 (0.41-0.77) | - | - |
| 3 or more | 0.49 (0.25-0.94) | - | - |
| ≥2 (delayed intubation)* | - | 0.55 (0.40-0.75) | - |
| Number of failed attempts (ordinal variable: OR per each incremental attempt) | - | - | 0.60 (0.38-0.96) |
| Age | |||
| 0-19 | 0.84 (0.40-1.80) | 0.84 (0.40-1.78) | 0.84 (0.40-1.80) |
| 20-39 | 0.82 (0.48-1.41) | 0.82 (0.48-1.40) | 0.82 (0.48-1.41) |
| 40-59 | 1.09 (0.69-1.74) | 1.09 (0.69-1.74) | 1.09 (0.69-1.74) |
| 60-79 | 1.22 (0.81-1.82) | 1.22 (0.81-1.82) | 1.22 (0.81-1.82) |
| 80-99 | 1 [reference] | 1 [reference] | 1 [reference] |
| Sex | |||
| Male | 1 [reference] | 1 [reference] | 1 [reference] |
| Female | 0.87 (0.64-1.18) | 0.87 (0.64-1.18) | 0.87 (0.64-1.18) |
| Primary indication | |||
| Cardiac arrest | 1 [reference] | 1 [reference] | 1 [reference] |
| Medical encounter | 0.70 (0.49-1.01) | 0.70 (0.49-1.00) | 0.70 (0.49-1.01) |
| Trauma encounter | 0.48 (0.30-0.76) | 0.48 (0.30-0.76) | 0.48 (0.30-0.76) |
| Change in method | |||
| No change | 1 [reference] | 1 [reference] | 1 [reference] |
| Rapid sequence intubation | 0.60 (0.26-1.41) | 0.61 (0.26-1.41) | 0.61 (0.26-1.41) |
| Sedation without paralytics | 0.26 (0.08-0.88) | 0.26 (0.08-0.88) | 0.26 (0.08-0.88) |
| Surgical cricothyrotomy | 1.96 (0.42-9.07) | 1.96 (0.42-9.04) | 1.96 (0.42-9.04) |
| Others† | 0.82 (0.23-2.95) | 0.81 (0.22-2.94) | 0.82 (0.23-2.95) |
| Change in device | |||
| No change | 1 [reference] | 1 [reference] | 1 [reference] |
| Direct laryngoscope | 1.51 (0.59-3.86) | 1.50 (0.59-3.85) | 1.51 (0.59-3.86) |
| Gum elastic bougie | 0.85 (0.41-1.77) | 0.85 (0.41-1.77) | 0.85 (0.41-1.77) |
| Video laryngoscope | 0.47 (0.22-0.96) | 0.46 (0.22-0.96) | 0.47 (0.22-0.96) |
| Fiberoptic bronchoscope | 0.23 (0.06-0.93) | 0.23 (0.06-0.94) | 0.23 (0.06-0.93) |
| Others‡ | 1.87 (0.20-17.39) | 1.89 (0.20-17.59) | 1.87 (0.20-17.45) |
| Change in intubator | |||
| No change | 1 [reference] | 1 [reference] | 1 [reference] |
| Transitional year resident§ | 0.25 (0.09-0.65) | 0.25 (0.09-0.65) | 0.25 (0.09-0.65) |
| Emergency medicine resident | 0.89 (0.45-1.77) | 0.89 (0.45-1.76) | 0.90 (0.45-1.78) |
| Emergency physician¶ | 1.15 (0.60-2.19) | 1.14 (0.60-2.18) | 1.15 (0.60-2.19) |
| Other specialty | 0.70 (0.34-1.47) | 0.70 (0.34-1.47) | 0.70 (0.34-1.47) |
Abbreviations: OR, odds ratio; CI, confidence intervals.
*Delayed rescue intubation was defined as the first rescue intubation attempt after two or more failed attempts.
†Defined as nasal intubation or paralytics without sedatives.
‡Defined as other types of direct laryngoscope, or supraglottic devices.
§Defined as post graduate years 1 or 2.
¶Defined as post graduate years ≥6.