Association Between Operator Experience and Procedural Outcomes of Tracheal Intubation in the Emergency Department and ICU

Study objectives Complications are common during emergency tracheal intubation. Although graduate medical education in emergency medicine and critical care mandate competency in this procedure, thresholds for proficiency are poorly defined. We evaluated the relationship between the operator performing intubation and complications of emergency tracheal intubation. Methods We performed a secondary analysis of data from 8 multicenter randomized trials of critically ill adults undergoing emergency tracheal intubation in an emergency department or ICU in the United States. We examined the relationship between an operator’s prior intubating experience and procedural outcomes, including successful intubation on the first attempt and lowest oxygen saturation. Results Among 2,839 intubations with data on prior intubating experience of the operator, 1,863 (65.6%) were by critical care medicine clinicians and 739 (26.0%) by emergency medicine clinicians. The median number of reported previous intubations by clinicians was 56.0 (interquartile range, 32 to 100). Greater intubation experience was associated with an increased odds of successful intubation on the first attempt (odds ratio [OR], 1.75; 95% confidence interval [CI], 1.30 to 2.36; P <.001) and increased lowest oxygen saturation (OR 1.45; 95% CI, 1.21 to 1.73; P <.001). Learning curves suggested a plateau effect between 35 and 50 intubations. Conclusion For tracheal intubations performed in an emergency department or ICU, intubating experience is associated with improved procedural outcomes, reaching a plateau outcome after a mean 35 to 50 previous intubations.