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Schauer SG, Krepps AR, Winkle JM, Wright FL, Fisher AD, April MD, Douin DJ. Characterizing emergency department surgical airway placement in the setting of trauma - Reply. Am J Emerg Med 2024; 86:159-160. [PMID: 39368863 DOI: 10.1016/j.ajem.2024.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2024] [Accepted: 09/27/2024] [Indexed: 10/07/2024] Open
Affiliation(s)
- Steven G Schauer
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA; Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, CO, USA.
| | - Amy R Krepps
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Julie M Winkle
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Franklin L Wright
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Michael D April
- 14(th) Field Hospital, Fort Stewart, GA, USA; Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - David J Douin
- Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA
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Nikolla DA, Offenbacher J, April MD, Smith SW, Battista A, Ducharme SA, Carlson JN, Brown CA. Emergency Medicine Postgraduate Year, Laryngoscopic View, and Endotracheal Tube Placement Success. Ann Emerg Med 2024; 84:11-19. [PMID: 38639674 DOI: 10.1016/j.annemergmed.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Revised: 02/28/2024] [Accepted: 03/07/2024] [Indexed: 04/20/2024]
Abstract
STUDY OBJECTIVE Prior work has found first-attempt success improves with emergency medicine (EM) postgraduate year (PGY). However, the association between PGY and laryngoscopic view - a key step in successful intubation - is unknown. We examined the relationship among PGY, laryngoscopic view (ie, Cormack-Lehane view), and first-attempt success. METHODS We performed a retrospective analysis of the National Emergency Airway Registry, including adult intubations by EM PGY 1 to 4 resident physicians. We used inverse probability weighting with propensity scores to balance confounders. We used weighted regression and model comparison to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CIs) between PGY and Cormack-Lehane view, tested the interaction between PGY and Cormack-Lehane view on first-attempt success, and examined the effect modification of Cormack-Lehane view on the association between PGY and first-attempt success. RESULTS After exclusions, we included 15,453 first attempts. Compared to PGY 1, the aORs for a higher Cormack-Lehane grade did not differ from PGY 2 (1.01; 95% CI 0.49 to 2.07), PGY 3 (0.92; 0.31 to 2.73), or PGY 4 (0.80; 0.31 to 2.04) groups. The interaction between PGY and Cormack-Lehane view was significant (P-interaction<0.001). In patients with Cormack-Lehane grade 3 or 4, the aORs for first-attempt success were higher for PGY 2 (1.80; 95% CI 1.17 to 2.77), PGY 3 (2.96; 1.66 to 5.27) and PGY 4 (3.10; 1.60 to 6.00) groups relative to PGY 1. CONCLUSION Compared with PGY 1, PGY 2, 3, and 4 resident physicians obtained similar Cormack-Lehane views but had higher first-attempt success when obtaining a grade 3 or 4 view.
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Affiliation(s)
| | - Joseph Offenbacher
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Michael D April
- 14th Field Hospital, Fort Stewart, GA; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Silas W Smith
- Ronald O. Perelman Department of Emergency Medicine, New York University Grossman School of Medicine, NYU Langone Health, New York, NY; Institute for Innovations in Medical Education, New York University Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Anthony Battista
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Scott A Ducharme
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA
| | - Calvin A Brown
- Department of Emergency Medicine, UMass Chan-Lahey Hospital and Medical Center, Burlington, MA
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Carlson JN, De Lorenzo R. Does Practice Make Perfect, or Is There More to Consider? Ann Emerg Med 2024; 84:9-10. [PMID: 38795080 DOI: 10.1016/j.annemergmed.2024.04.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 04/12/2024] [Indexed: 05/27/2024]
Affiliation(s)
- Jestin N Carlson
- Department of Emergency Medicine, Allegheny Health Network, Erie, PA.
| | - Robert De Lorenzo
- Department of Emergency Medicine, University of Texas Health San Antonio, San Antonio, TX
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April MD, Bridwell RE, Davis WT, Oliver JJ, Long B, Fisher AD, Ginde AA, Schauer SG. Interventions associated with survival after prehospital intubation in the deployed combat setting. Am J Emerg Med 2024; 79:79-84. [PMID: 38401229 DOI: 10.1016/j.ajem.2024.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/19/2023] [Accepted: 01/30/2024] [Indexed: 02/26/2024] Open
Abstract
INTRODUCTION Airway compromise is the second leading cause of potentially preventable death on the battlefield. Prehospital airway management is often unavoidable in a kinetic combat environment and expected to increase in future wars where timely evacuation will be unreliable and air superiority not guaranteed. We compared characteristics of survivors to non-survivors among combat casualties undergoing prehospital airway intubation. MATERIALS AND METHODS We requested all Department of Defense Trauma Registry (DODTR) encounters during 2007-2023 with documentation of any airway intervention or assessment within the first 72-h after injury. We conducted a retrospective cohort study of all casualties with intubation documented in the prehospital setting. We used descriptive and inferential statistical analysis to compare survivors through 7 days post injury versus non-survivors. We constructed 3 multivariable logistic regression models to test for associations between interventions and 7-day survival after adjusting for injury severity score, mechanism of injury, and receipt of sedatives, paralytics, and blood products. RESULTS There were 1377 of 48,301 patients with documentation of prehospital intubation in a combat setting. Of these, 1028 (75%) survived through 7 days post injury. Higher proportions of survivors received ketamine, paralytic agents, parenteral opioids, and parenteral benzodiazepines; there was no difference in the proportions of survivors versus non-survivors receiving etomidate. The multivariable models consistently demonstrated positive associations between 7-day survival and receipt of non-depolarizing paralytics and opioid analgesics. CONCLUSIONS We found an association between non-depolarizing paralytic and opioid receipt with 7-day survival among patients undergoing prehospital intubation. The literature would benefit from future multi-center randomized controlled trials to establish optimal pharmacologic strategies for trauma patients undergoing prehospital intubation.
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Affiliation(s)
- Michael D April
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; 14th Field Hospital, Fort Stewart, GA, USA.
| | - Rachel E Bridwell
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - William T Davis
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Joshua J Oliver
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Department of Emergency Medicine, Madigan Army Medical Center, Joint Base Lewis-McChord, WA, USA
| | - Brit Long
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Andrew D Fisher
- Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Adit A Ginde
- Departments of Emergency Medicine and Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven G Schauer
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA; Departments of Emergency Medicine and Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, CO, USA
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Pillai S, Watson O, Grégoire J, Kakarla S, Ellis J, Ainsworth J, Kumar K, Oliver G. Journal update monthly top five. Emerg Med J 2023; 41:62-63. [PMID: 38135449 DOI: 10.1136/emermed-2023-213793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/02/2023] [Indexed: 12/24/2023]
Affiliation(s)
- Suresh Pillai
- Emergency Department, Morriston Hospital, Swansea, UK
| | - Oliver Watson
- Emergency Department, Morriston Hospital, Swansea, UK
| | | | - Siva Kakarla
- Emergency Department, Morriston Hospital, Swansea, UK
| | - James Ellis
- Emergency Department, Morriston Hospital, Swansea, UK
| | - James Ainsworth
- Ed Major Intensive Care Unit, Morriston Hospital, Swansea, UK
| | - Katy Kumar
- Emergency Department, Morriston Hospital, Swansea, UK
| | - Govind Oliver
- Wythenshawe Emergency Department, Manchester University NHS Foundation Trust, Manchester, UK
- Clinical Research Fellow, Grounded Research Team, Rotherham Doncaster and South Humber Mental Health NHS Foundation Trust, Doncaster, UK
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