The aim of this study was to identify the factors associated with successful second and third attempts in adults following a failed first intubation attempt in the emergency department (ED).

This was a retrospective analysis of the data from a multicenter, prospective, observational airway registry in South Korea. We obtained demographic and clinical data of intubated adult patients in 6 academic EDs from January 2007 to December 2010. The primary outcome was successful rescue attempt, which was defined as the successful placement of an endotracheal tube following a failed first intubation attempt. Logistic regression analyses were conducted to develop a multivariate model identifying factors associated with successful second and third attempts.

Of 5905 adult patients, 1122 (19.0%) failed a first intubation attempt. The success rates of the second and third attempts were 79.2% and 78.5%, respectively. In the multivariate logistic regression analysis, factors associated with a successful second attempt were emergency physicians, senior physicians, nondifficult airway, and the use of a rapid sequence intubation (RSI) (odds ratio = 2.81 [95% confidence interval, 1.80-4.37], 1.50 [1.10-2.07], 2.15 [1.53-3.01], and 1.53 [1.01-2.33], respectively). Nondifficult airway and the use of RSI were associated with successful third attempts (5.48 [2.69-11.18] and 2.63 [1.08-6.40], respectively).

Nondifficult airway and the use of RSI were associated with successful second and third intubation attempts. The use of RSI, backup by experienced senior physicians, and preparation for management of a difficult airway could be strategies for successful rescue intubation attempts in the ED.