The importance of the number of Tracheal Intubation attempts at the Emergency Department of King Abdullah Specialized Childrens Hospital in Riyadh, Saudi Arabia

Background: Tracheal intubation (TI) is an intervention in the Emergency Department (ED) to stabilise children and to protect the airway. The aim of the study was to investigate the prevalence of TI, the number of attempts to achieve successful intubation, the indications and the adverse outcomes related to TI in the paediatric population. Methods: A quantitative cross-sectional study, using a chart review of the hospital's electronic database, was conducted with paediatric patients who required intubation, from May 2015 to the current date. Results: A total of 159 paediatric patients' records were analysed. The proportion of a successful first intubation attempt was 87.4% (n = 139), two attempts 6.9% (n = 11), and three or more attempts 5.7% (n = 9). The most frequent indication for TI in the sample was trauma (35.3%, n = 55). In terms of TI-related complications, 22% (n = 35) experienced at least one complication. Of the successful first attempt group, cardiac arrest without return of spontaneous circulation (ROCS) was observed in 12.9% (n = 18). Other TI-related adverse events included hypotension requiring treatment (5.8%, n = 8), emesis (1.4%), bleeding through the tube (2.9%) and secretions via the tube (2.9%). For the two attempts group (n = 11), 18.2% (n = 2) had secretions from the tube and 18.2% experienced bleeding through the tube. For the three or more attempts group, cardiac arrest with ROCS (22.2%, n = 2), and secretions from the tube (22.2%, n = 2), were observed. The majority (96.2%) of the patients had a successful extubation, 8.7% (n = 13) experienced postextubation stridor, 2% (n = 3) became agitated, and 5.3% (n = 8) experienced respiratory distress. Conclusion: The TI success rate was 87.4%, and adverse outcomes occurred in 22% of all attempts. There is a higher prevalence of TI-related adverse events with multiple attempts to intubate. It is urgent that ED healthcare providers maximise their efforts to achieve success with the first intubation.