Impact of an Anesthesiology Rotation on Subsequent Endotracheal Intubation Success

摘要

What was known Added opportunities to perform endotracheal intubation (ETI) during residency may result in improved emergency medicine (EM) resident success for this procedure.;What is new An additional anesthesiology rotation for EM residents increases the number of opportunities to perform ETI.;Limitations Single-site study and small sample size limit generalizability, as well as possible reporting bias from faculty raters.;Bottom line The additional anesthesiology rotation did not have a significant effect on residents' ETI success or adverse event rates.;Introduction Endotracheal intubation (ETI) is an essential skill for emergency department (ED) physicians. Emergency medicine (EM) residents gain experience with ETI throughout their training. A large multicenter study reported high levels of EM resident success with ETI.1 As residents perform more ETIs, their success rate, commonly defined as first- or second-attempt successful passage of the endotracheal tube, should improve. One study defined the “learning curve” for ETI success rate at 90% (95% confidence interval [CI], 0.80–0.99) after a median of 57 ETI attempts.2 Another report suggested that postgraduate year (PGY)-1 residents completing a 1-month anesthesiology rotation required approximately 19 intubation attempts to complete the learning curve.3 The learning curve for paramedic students with a success rate of 96% was reported at a median of 30 ETI attempts.4 These studies show considerable variation in the learning curve among individual trainees and the different environments for intubations, including the emergency department, operating room, prehospital setting, and intensive care unit. The EM residency programs must consider the number of intubation opportunities for their residents, residents' projected learning curve, and variations in the potential for learning among potential intubation environments. The Accreditation Council for Graduate Medical Education (ACGME) recommends a minimum of 35 ETI attempts during EM residency, but there is no way to determine the ideal number of ETI attempts for a given EM resident. The ED, the intensive care unit, and the operating room are common clinical venues for EM residents to gain ETI experience. To increase the number of intubation opportunities provided to residents, approximately 87% of US allopathic EM residencies have a required anesthesiology rotation. Most of these rotations are conducted in PGY-1, with 55% being 4-week rotations and 45% being less than 4?weeks or hybrid rotations.5 The purpose of this study was to evaluate the effect of implementing a PGY-1 anesthesiology rotation on residents' ETI success in the ED during PGY-2. We hypothesized that residents who had an anesthesiology rotation during PGY-1 would be more successful and have less adverse events with ETI during the first 6?months of PGY-2 than would residents who did not experience such a rotation.;Methods Study Setting and Design We conducted a prospective, observational study that compared ETI success rates and adverse events of 2 resident groups in the Indiana University EM residency program during the first 6?months of their PGY-2. Residents in the study group (N ?=? 18) participated in a 4-week anesthesiology rotation (AR) in PGY-1, which replaced a radiology rotation. Control group residents (N ?=? 17) did not have a PGY-1 anesthesiology rotation (NO-AR). Information about ETIs performed by the 2 groups during the study was recorded by faculty on Airway Cards. All ETIs performed during the study occurred in the ED at the residency's 2 urban, level-1 trauma centers.;Results Analysis of self-maintained procedure logs suggested the AR group had a mean of 53 ETI attempts per resident in PGY-1, and the NO-AR group had a mean of 21 ETI attempts per resident during PGY-1 (table?1). View larger version (10K) table 1Resident Demographics;Discussion The study group residents' additional ETI experience during a PGY-1, anesthesiology, 4-week rotatio