Lucas Oliveira J E Silva, Rafael Von Hellmann, Bruno A M Pinheiro Besen, Julia M Dorn de Carvalho, Ludhmila Abrahao Hajjar, Daniel Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A Vinholes Filho, Andre P Weber, Vinicius da Silva Castro, Carlos Fernando D Dornelles, Barbara S Tabach, Hélio P Guimarães, Gabriela Stanzani, Thiago F Gava, Aidan Mullan, Gabriel Petrin Alonso Silva, Giovanna Cardoso de Oliveira, Benjamin J Sandefur, Fernanda Bellolio, Julio C G Alencar, Ian Ward A Maia
{"title":"急诊科医师专业与首次插管成功率的关系。","authors":"Lucas Oliveira J E Silva, Rafael Von Hellmann, Bruno A M Pinheiro Besen, Julia M Dorn de Carvalho, Ludhmila Abrahao Hajjar, Daniel Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A Vinholes Filho, Andre P Weber, Vinicius da Silva Castro, Carlos Fernando D Dornelles, Barbara S Tabach, Hélio P Guimarães, Gabriela Stanzani, Thiago F Gava, Aidan Mullan, Gabriel Petrin Alonso Silva, Giovanna Cardoso de Oliveira, Benjamin J Sandefur, Fernanda Bellolio, Julio C G Alencar, Ian Ward A Maia","doi":"10.1097/MEJ.0000000000001276","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and importance: </strong>Emergency airway management in the emergency department (ED) is a high-risk procedure associated with patient outcomes. First-attempt success is a widely recognized quality metric, as multiple attempts are associated with an increased risk of peri-intubation complications. In Brazil, where emergency medicine is a recently established specialty, many ED are staffed by physicians without formal emergency medicine training. The association between emergency medicine training and intubation outcomes in this setting has not been well characterized.</p><p><strong>Objective: </strong>To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs.</p><p><strong>Design: </strong>Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation.</p><p><strong>Setting and participants: </strong>This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes.</p><p><strong>Main results: </strong>Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34-1.97]. There was also a higher odds of intubations without major complications (aOR: 1.20, 95% CI: 1.01-1.42).</p><p><strong>Conclusion: </strong>In this study, there was a higher rate of first-attempt success in intubations performed by board-certified emergency physicians compared with other physicians working in Brazilian EDs.</p>","PeriodicalId":11893,"journal":{"name":"European Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":4.2000,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Association between physician specialty and first-attempt intubation success in the emergency department.\",\"authors\":\"Lucas Oliveira J E Silva, Rafael Von Hellmann, Bruno A M Pinheiro Besen, Julia M Dorn de Carvalho, Ludhmila Abrahao Hajjar, Daniel Pedrollo, Caio Goncalves Nogueira, Natalia Mansur P Figueiredo, Carlos Henrique Miranda, Danilo Martins, Thiago Dias Baumgratz, Bruno Bergesch, Diogo Costa, Osmar Colleoni, Juliana Zanettini, Ana Paula Freitas, Nicole Pinheiro Moreira, Patricia Lopes Gaspar, Renato Tambelli, Maria Cristina Costa, Samara Silveira, Wilsterman Correia, Rafael Garcia de Maria, Ubirajara A Vinholes Filho, Andre P Weber, Vinicius da Silva Castro, Carlos Fernando D Dornelles, Barbara S Tabach, Hélio P Guimarães, Gabriela Stanzani, Thiago F Gava, Aidan Mullan, Gabriel Petrin Alonso Silva, Giovanna Cardoso de Oliveira, Benjamin J Sandefur, Fernanda Bellolio, Julio C G Alencar, Ian Ward A Maia\",\"doi\":\"10.1097/MEJ.0000000000001276\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and importance: </strong>Emergency airway management in the emergency department (ED) is a high-risk procedure associated with patient outcomes. First-attempt success is a widely recognized quality metric, as multiple attempts are associated with an increased risk of peri-intubation complications. In Brazil, where emergency medicine is a recently established specialty, many ED are staffed by physicians without formal emergency medicine training. The association between emergency medicine training and intubation outcomes in this setting has not been well characterized.</p><p><strong>Objective: </strong>To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs.</p><p><strong>Design: </strong>Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation.</p><p><strong>Setting and participants: </strong>This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine.</p><p><strong>Outcome measures and analysis: </strong>The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes.</p><p><strong>Main results: </strong>Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34-1.97]. 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Association between physician specialty and first-attempt intubation success in the emergency department.
Background and importance: Emergency airway management in the emergency department (ED) is a high-risk procedure associated with patient outcomes. First-attempt success is a widely recognized quality metric, as multiple attempts are associated with an increased risk of peri-intubation complications. In Brazil, where emergency medicine is a recently established specialty, many ED are staffed by physicians without formal emergency medicine training. The association between emergency medicine training and intubation outcomes in this setting has not been well characterized.
Objective: To assess the association of physician specialty with first-attempt success and immediate peri-intubation complications in Brazilian EDs.
Design: Secondary analysis of a multicenter, prospective cohort study from the Brazilian Airway Registry Cooperation.
Setting and participants: This study included adult patients who underwent tracheal intubation in EDs between March 2022 and April 2024. Patients were excluded if the intubation occurred outside the ED, during cardiopulmonary resuscitation, or for elective procedures. Intubations performed by medical students were also excluded. Physicians were categorized by specialty as emergency medicine or nonemergency medicine.
Outcome measures and analysis: The primary outcome was first-attempt success; secondary outcomes included peri-intubation complications (severe hypoxemia, hemodynamic instability, and cardiac arrest). Multivariable logistic regression was used to assess the association between physician specialty and outcomes.
Main results: Among 2582 patients, 1087 (42.1%) were intubated by emergency physicians and 1495 (57.9%) by other physicians (mainly internal medicine and surgery). Intubations by emergency physicians were associated with a higher rate of first-attempt success [80.4 vs. 70.9%, adjusted odds ratio [aOR]: 1.63, 95% confidence interval (CI): 1.34-1.97]. There was also a higher odds of intubations without major complications (aOR: 1.20, 95% CI: 1.01-1.42).
Conclusion: In this study, there was a higher rate of first-attempt success in intubations performed by board-certified emergency physicians compared with other physicians working in Brazilian EDs.
期刊介绍：
The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field.
Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community.
Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool.
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