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Acad Emerg Med. 2019 May 22. doi: 10.1111/acem.13805. [Epub ahead of print]

Multicenter Comparison of Non-supine versus Supine Positioning During Intubation in the Emergency Department: A National Emergency Airway Registry (NEAR) Study.

Author information

1
Division of Emergency Medicine, University of Utah, Salt Lake City, UT, USA.
2
Department of Emergency Medicine, Harbor - UCLA, Torrance, CA, USA.
3
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, MA, USA.

Abstract

OBJECTIVE:

Head-up positioning for preoxygenation and ramping for morbidly obese patients are well accepted techniques, but the effect of head-up positioning with full torso elevation for all intubations is controversial. We compared first-pass success, adverse events, and glottic view between supine (SP) and non-supine (NSP) positioning for emergency department (ED) patients undergoing orotracheal intubation.

METHODS:

We performed a retrospective analysis of prospectively collected data for ED intubations over a two-year period from 25 participating centers in the National Emergency Airway Registry (NEAR). We compared characteristics and outcomes for adult patients intubated orotracheally in SP and NSP positions with either a direct or video laryngoscope. We report odds ratios (OR) with 95%CI for categorical variables and interquartile ranges with 95%CI for continuous variables. Our primary outcome was first-attempt intubation success and secondary outcomes were glottic views and peri-intubation adverse events.

RESULTS:

Of 11,480 total intubations, 5.8% were performed in NSP. The NSP group included significantly more obese patients (OR 2.2 [95% CI 1.9-2.6]) and patients with a suspected difficult airway (OR 1.8 [95% CI 1.6-2.2]). First-pass success (adjusted OR 1.1 [95% CI 0.9-1.4]) and overall rate of grade I glottic views (OR =1.1 [95% CI 0.9-1.2]) were similar between groups while NSP had a significantly higher rate of grade I views when direct laryngoscopy was employed (OR = 1.27 [95% CI 1.04-1.54]). NSP was associated with higher odds of any adverse event (OR 1.4 [95% CI 1.1-1.7]).

CONCLUSIONS:

ED providers utilized SP in most ED intubations but were more likely to use NSP for patients who were obese or in whom they predicted a difficult airway. We found no differences in first-pass success between groups but total adverse events were more likely in NSP. A randomized trial comparing patient positioning during intubation in the ED is warranted. This article is protected by copyright. All rights reserved.

PMID:
31116893
DOI:
10.1111/acem.13805

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