Emergency Airway Management in Japan: a Multi-center Prospective Observational Study

1. Emergency Airway Management in Japan:a Multi-center Prospective Observational Study Hasegawa K, M.D.; Hagiwara Y, M.D, M.P.H.; Chiba T, M.D.;Watase H, M.D.; Walls MR, M.D.; Brown III CA, M.D; Brown DFM, M.D. on behalf of the JEMRA investigators

2. Conflict of InterestFunding There are no conflicts to declare. Funding • St. Luke’s Life Science Institute Grant (Hasegawa) • Harvard Affiliated Emergency Medicine Residency (Hasegawa)

3. BACKGROUND • Emergency medicine is increasingly recognized as a medical specialty in Japan, • Comprehensive studies evaluating emergency airway management practice are lacking.

4. OBJECTIVES To describe • emergency intubation indications • methods used to intubate • success rates • adverse event rates

5. METHODSStudy Design • a prospective observational multi-center data registry • with all data collectionplanned a priori • IRBof each center has approved theprotocol, with waiver for informed consent.

6. Study Setting • the Japanese Emergency Airway Network (JEAN) • a consortium of 10 academic & community ED • 9 affiliatedwith EMresidency • Level I (n=9) or Level II equivalent (n=1) trauma • an average ED census of 27,000 patient visits/y • range, 9,000 to 42,000

7. Selection of Participants • Eligible for inclusion: • All patients who presented to 10 EDs and • Underwent endotrachealintubation • Gatheredprospectively during an 11-month period • April 2010 to February2011

8. Measurements • We report information about the distribution of: • Indications for intubation. • Methods used to intubate. • Success rate of intubation by method. • Adverse event rates Using simple descriptive statistics.

9. RESULTS • For the 11-month pilot period, • 1,490 eligible patients. • Database recorded 1,486 intubations (compliance rate 99.7%).

10. Principal Indication for Intubation

11. Initial Method of Airway Management

12. Success for Initial Method

15. DISCUSSIONpractice variations • We are struck by a high degree of variations in airway management practices among sites. • Because of the non-controlled nature of this study, the reasons for this variation are not well defined. • Confounding by indication? • Physician’s preference?

16. Variations in Success The variability in the method of intubation may, in part, account for this variation Potentially confounded by unmeasured variables Assuming validities of our observations, this study hints at the need for efforts to improve ED airway management quality.

17. LIMITATIONS • Reporting bias • Outcomes not measured • Unmeasured confounders • External validity

18. CONCLUSIONS • a high overall intubation success rate • a high degree of variations among hospitals inemergency airway management. • Our studyprovides a starting point to improve the quality of airway management.

19. ACKNOWLEDGEMENT The authors acknowledge the following research personnel at the study sites: • Fukui University Hospital (Hideya Nagai, MD, Hiroshi Morita MD) • Fukui Prefectural Hospital (Yukinori Kato, MD, Hidenori Higashi, MD) • Japanese Red Cross Medical Center of Wakayama (Hiroshi Okamoto, MD) • Kameda Medical Center (Kenzo Tanaka, MD) • National Center for Global Health and Medicine (Taigo Sakamoto, MD, ShunichiroNakao, MD) • Nagoya Ekisaikai Hospital (Shigeki Tsuboi, MD) • Nigata City General Hospital (Nobuhiro Sato, MD) • Obama Municipal Hospital (Takuyo Chiba, MD) • Okinawa Chubu Prefectural Hospital (Masashi Okubo,MD) • Osaka SaiseikaiSenri Hospital (Kazuaki Shigemitsu, MD, Shuho Sato, MD) We are grateful to our many emergency physicians and residents for their perseverance in pursuing new knowledge about this vital resuscitative procedure

20. Intubator Demographics