IMPORTANCE OF FIRST PASS INTUBATION OUT OF OPERATING THEATRES

These intubations are performed on often critically ill patients who have an additional aspiration risk.

J.C. Sakles et al. 44 studied over a 4-year  period 1,828 orotracheal intubations in emergency departments

Adverse Events (AEs)  included aspiration, oxygen desaturation, oesophageal intubation, hypotension, dysrhythmia, and cardiac arrest

Intubation successful incidence of one or more AEs
first attempt 14.2%
requiring 2 attempts 47.2%
requiring 3 attempts 63.6%
requiring 4 or more attempts 70.6%

CONCLUSIONS:
When performing orotracheal intubation in the ED, first pass success is associated with a relatively small incidence of AEs. As the number of attempts increases, the incidence of AEs increases substantially.