Incidence and Outcomes of Emergency Physician-Performed Awake Intubations: A Report From the Airway Interventions Registry and Observational Database.

Abstract

To determine the incidence, practice patterns, and outcomes of emergency physician-performed awake tracheal intubations in a tertiary-care emergency department (ED). In this study of the prospective Airway Interventions Registry and Observational database, we screened all intubations performed at an academic, tertiary-care ED between January 1, 2015, and January 1, 2025, for adults undergoing first-attempt awake tracheal intubation by an emergency physician. We excluded patients undergoing sedation-only or dissociation-only intubation. Our primary outcome was overall success without any of the following major adverse events: critical hypoxemia (SpO₂<80%), critical hypotension (systolic blood pressure<65 mmHg), or cardiac arrest. Our secondary outcomes were the frequencies of first-pass success, adverse events, and conversion to rapid sequence intubation. Among the 1,213 ED intubations screened during the 10-year study period, 87 (7.2%) were emergency physician-performed awake intubations. Most patients undergoing awake intubation had anatomic (80%) or physiologic (87%) predictors of difficulty, or both (68%). Success without a major adverse event occurred in 80 (92%; 95% confidence interval 86% to 98%) patients. There was first-pass success in 62 (71%) and rapid sequence intubation conversion in 6 (6.9%) patients. Critical hypoxemia, critical hypotension, and cardiac arrest occurred in 3%, 2%, and 2%, respectively. In this preliminary single-center study, emergency physicians performed awake intubation with relatively high incidence, high overall success, and low rates of major adverse events.