Abstract
Background:
While respiratory therapists (RTs) have historically provided safe and effective intubation services, there are limited multicenter data assessing RT intubation performance. Multicenter data can be used compare RT intubation performance to other professions and identify quality assurance (QA) opportunities at hospitals where RTs provide intubation. Our aim was to create a quality assurance tool that could be used at multiple centers to evaluate intubation outcomes of RTs.
Methods:
A QA tool was developed by the authors and implemented at two institutions. Following IRB approval at each center and completion of a data-use sharing agreement, data were combined for analysis. Intubations were recorded between May 25, 2020, and April 30, 2022. Statistical analysis was descriptive with comparisons in overall success rate, first attempt success rate, adverse events, and type of laryngoscopy between centers.
Results:
A total of 689 intubations where RTs made at least one attempt, 363 from center A and 326 from center B were captured. Center A captured 85% of all RT intubation attempts and center B captured 63%. Overall, RTs were successful in 98% of attempts. RTs made 86% of initial attempts. The most common indications for intubation were cardiac arrest (42%), respiratory failure (31%), and other (27%). Video laryngoscopy was used during 65% of initial attempts. Airway-related adverse event rate was 8.7%, physiologic adverse event rate was 16%, and desaturation rate was 11%. RTs at center B were more likely to make the first attempt and use video laryngoscopy, while intubations at center A were more likely to be done during cardiac arrests.
Conclusions:
A QA tool examining RTs intubation service was successfully initiated and used at two separate facilities. The success rate for RTs was high and adverse event rates were comparable to published results from other providers. The most common indication for RT intubation was cardiac arrest and the most common laryngoscopy was video.
RT Intubation Data From Two Institutions
All
Center A
Center B
P
Total Patients RTs attempted
689
363
326
Overall success rate
675 (98.0%)
358 (98.6%)
317 (97.2%)
0.48
RT made initial attempt
589 (85.5%)
294 (81.0%)
295 (90.5%)
<0.001
Successful on first RT attempt
622 (90.3%)
321 (88.4%)
301 (92.3%)
0.084
Primary Indication for intubation
Cardiac arrest
288 (41.8%)
167 (46.0%)
121 (37.1%)
<0.001
Respiratory failure
213 (30.9%)
113 (31.1%)
100 (30.7%)
All Others
188 (27.2%)
83 (22.8%)
105 (32.2%)
First attempt laryngoscopy method
Direct
239 (34.7%)
136 (37.5%)
103 (31.6%)
0.035
Video
429 (62.3%)
211 (58.1%)
218 (66.9%)
Both
10 (1.5%)
8 (2.2%)
2 (0.6%)
Unclear
11 (1.6%)
8 (2.2%)
3 (0.9%)
Get full access to this article
View all access options for this article.