Transitioning From Anesthesia to Emergency Medicine for Airway Management in Rural Trauma Patients

Introduction: When our rural trauma center first became certified in 1986, the Emergency Department (ED) was a mix of board-certified Emergency Medicine (EM) and Family Medicine trained physicians each with various degrees of airway experience. Therefore, Anesthesia providers had provided airway management during trauma activations for decades. Recently, our institution saw dramatic growth in the ED which is now staffed by board certified EM physicians and complemented by an EM residency program. This prompted the institution to enact a policy change transitioning airway management during trauma activations from Anesthesiology to EM. The authors hypothesized that this policy change was not associated with a reduced rate of successful first pass intubations in trauma patients.

Methods: A retrospective analysis was performed of all trauma activations requiring intubation from March 1, 2018, to January 31, 2023. The ED assumed responsibility for airway management March 1, 2021. These patients were then divided into two groups; the pregroup, representing airways managed by Anesthesiology, and the postgroup representing airways managed by EM. The primary outcome was the rate of successful intubation performed on the first pass. Secondary outcomes included periprocedural vital signs and presence of airway management associated complication.

Results: The pregroup included 71 patients while the postgroup included 58 patients with full documentation meeting our criteria. We found no difference in the rate of successful first pass intubations between the pregroup and postgroup (85.90% versus 87.9%, P = 0.736). Both groups had 100% intubation success rates on the second pass. There were no significant differences between groups across the majority of secondary outcomes measured.

Conclusions: The transition in airway management of the trauma patient from anesthesiology to the ED in a rural Level II trauma center found no difference regarding successful first pass intubations in the trauma bay.