Airway managed by emergency physicians or anaesthesiologists in trauma patients: A retrospective cohort analysis of outcomes

Abstract Objectives In some trauma centres, anaesthesiologists (AN) has the primary responsibility of managing airway in trauma resuscitation. However, as emergency physicians(EP) establishes a separate specialty with airway management and endotracheal intubation being one of the core skills, role delineation within trauma members may vary. In this cohort study, we aim to determine the difference in mortality of trauma patients requiring intubation in the Emergency Department between EP and AN. Methods We screened all 1588 patients in the hospital trauma registry from 2015 to 2018. We included all patients requiring endotracheal intubation and aged 18 or above but excluded those with pregnancy, presented with cardiac arrest and secondarily transferred from other hospitals. 349 eligible patients were sorted into two cohorts according to the physicians who performed intubations (AN 205 patients, EP 144 patients). Patients' baseline demographics, 30-day all-cause mortality, and other predefined secondary outcomes were compared by statistical tests. Stepwise logistic regression of 30-day all-cause mortality were performed. Results Our study has shown that intubation by emergency physicians was not associated with higher 30-day all-cause mortality after potential confounders were controlled by logistic regression. (adjusted OR 1.253, p = 0.607) Both group also did not differ in other clinical important secondary outcomes, including proportion of successful intubations, use of surgical airway or rescue manoeuvres, respiratory and airway complications , mortality in intensive care or high-dependency unit, post-intubation cardiac arrest , post-intubation hypotension and post-intubation hypoxia. Conclusion Endotracheal intubation by EP is not associated with increased 30-day all-cause mortality when compared to AN after accounting for confounders.