Emergency Department Airway Management for Status Asthmaticus With Respiratory Failure

BACKGROUND: Data are limited regarding current practice and outcomes for emergency department airway management in status asthmaticus. This paper describes the foremost methods and outcomes of airway management in patients in the emergency department who required intubation for status asthmaticus.

METHODS: We analyzed all intubations with a primary indication of asthma over a 3-y period (January 1, 2016 to December 31, 2018) using the National Emergency Airway Registry (NEAR), a 25-center, prospective, observational registry of emergency department intubations. We report the incidence of intubations for asthma, methods and medications used, devices used, peri-intubation adverse events, and intubation success and failures using univariate descriptive statistics and cluster-adjusted incidence with 95% CI.

RESULTS: A total of 19,071 encounters were recorded during the study period, with 14,517 patients intubated for medical indications. Of those, 173 (1.2%, 95% CI 0.9-1.6) were intubated for asthma. The first-attempt success rate was 90.8% (95% CI 81.9–95.5), and overall intubation success was 100%. Compared to the medical registry as a whole, patients with asthma were more likely to undergo rapid-sequence intubation (96.5% [95% CI 92.9–98.3] vs 80.8% [95% CI 75.1–82.5]), preoxygenation with bi-level positive airway pressure (BPAP) (62.9% [95% CI 49.6–74.6] vs 13.5% (95% CI 10.4–16.9]), and induction with ketamine (51.8% [95% CI 30.6–71.4] vs 11.6% [95% CI 7.6–16.8]). The adverse event rate in the patients with asthma was 12.14% (95% CI 8.1–17.9) compared to 11.93% (95% CI 9.79–14.12) in the medical registry.

CONCLUSIONS: Status asthmaticus accounted for about 1% of emergent medical intubations. The majority of patients were intubated using rapid-sequence intubation after preoxygenation with BPAP and induction with ketamine, with the latter 2 practices being much more common for emergent intubations for status asthmaticus than for other medical indications.