Bed tilt and ramp positions are associated with increased first-pass success of adult endotracheal intubation in the emergency department : A registry study

Journal article


Bennett, Samantha, Alkhouri, Hatem, Hawke, Helen, Long, Elliot, Chan, Trevor, Vassiliadis, John and Fogg, Toby. (2023). Bed tilt and ramp positions are associated with increased first-pass success of adult endotracheal intubation in the emergency department : A registry study. Emergency Medicine Australasia. 35(6), pp. 983-990. https://doi.org/10.1111/1742-6723.14276
AuthorsBennett, Samantha, Alkhouri, Hatem, Hawke, Helen, Long, Elliot, Chan, Trevor, Vassiliadis, John and Fogg, Toby
Abstract

Objective
Successful endotracheal intubation in the ED requires optimum body positioning. In patients with obesity, the ramp position was suggested to achieve better intubating conditions. However, limited data are available on the airway management practices for patients with obesity in Australasian EDs. The aim of this study was to identify current patient positioning practices during endotracheal intubation and its association with first-pass success (FPS) at intubation and adverse event (AE) rates in obese and non-obese populations.

Methods
Prospectively collected data from the Australia and New Zealand ED Airway Registry (ANZEDAR) between 2012 and 2019 were analysed. Patients were categorised into two groups according to their weight: <100 kg (non-obese) or ≥100 kg (obese). Four position categories were investigated; supine, pillow or occipital pad, bed tilt and ramp or head-up with relation to FPS and complication rate using logistic regression modelling.

Results
A total of 3708 intubations from 43 EDs were included. Overall, the non-obese cohort had a greater FPS rate (85.9%) compared to the obese group (77.0%). The bed tilt position had the highest FPS rate (87.2%), whereas the supine position had the lowest (83.0%). AE rates were highest in the ramp position (31.2%) compared to all other positions (23.8%). Regression analysis showed ramp, or bed tilt positions and a consultant-level intubator were associated with higher FPS. Obesity, in addition to other factors, was independently associated with lower FPS.

Conclusion
Obesity was associated with lower FPS, which could be improved through performing a bed tilt or ramp positioning.

Keywordsairway management; airway registry; emergency department; patient position; successful intubation
Year2023
JournalEmergency Medicine Australasia
Journal citation35 (6), pp. 983-990
PublisherJohn Wiley & Sons Australia, Ltd
ISSN1742-6731
Digital Object Identifier (DOI)https://doi.org/10.1111/1742-6723.14276
PubMed ID37429648
Scopus EID2-s2.0-85164664805
Open accessPublished as ‘gold’ (paid) open access
Page range983-990
FunderEmergency Care Institute (ECI)
Publisher's version
License
File Access Level
Open
Output statusPublished
Publication dates
Online10 Jul 2023
Publication process dates
Accepted19 Jun 2023
Deposited02 Apr 2025
Additional information

© 2023 The Authors. Emergency Medicine Australasia published by John Wiley & Sons Australia, Ltd on behalf of Australasian College for Emergency Medicine.

This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

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