{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T20:45:51Z","timestamp":1785357951290,"version":"3.55.0"},"reference-count":32,"publisher":"Academy of Medicine, Singapore","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Ann Acad Med Singap"],"published-print":{"date-parts":[[2021,1,31]]},"abstract":"<jats:p>ABSTRACT Introduction: Intubations in the emergency department (ED) are often performed immediately without the benefit of pre-selection or the ability to defer. Multicentre observational data provide a framework for understanding emergency airway management but regional practice variation may exist. We aim to describe the intubation indications, prevalence of difficult airway features, peri-intubation adverse events and intubator characteristics in the ED of the National University Hospital, Singapore. Methods: We conducted a prospective observational study over a period of 31 months from 1 March 2016 to 28 September 2018. Information regarding each intubation attempt, such as indications for intubation, airway assessment, intubation techniques used, peri-intubation adverse events, and clinical outcomes, was collected and described. Results: There were 669 patients, with male predominance (67.3%, 450\/669) and mean age of 60.9 years (standard deviation [SD] 18.1). Of these, 25.6% were obese or grossly obese and majority were intubated due to medical indications (84.8%, 567\/669). Emergency physicians\u2019 initial impression of difficult airway correlated with a higher grade of glottis view on laryngoscopy. First-pass intubation success rate was 86.5%, with hypoxia (11.2%, 75\/669) and hypotension (3.7%, 25\/669) reported as the two most common adverse events. Majority was rapid sequence intubation (67.3%, 450\/669) and the device used was most frequently a video laryngoscope (75.6%, 506\/669). More than half of the intubations were performed by postgraduate clinicians in year 5 and above, clinical fellows or attending physicians. Conclusion: In our centre, the majority of emergency intubations were performed for medical indications by senior doctors utilising rapid sequence intubation and video laryngoscopy with good ffirst-attempt success. Keywords: Difficult airway, emergency services, intubation, peri-intubation adverse events, rapid sequence induction<\/jats:p>","DOI":"10.47102\/annals-acadmedsg.2020331","type":"journal-article","created":{"date-parts":[[2021,2,15]],"date-time":"2021-02-15T10:09:59Z","timestamp":1613383799000},"page":"42-51","source":"Crossref","is-referenced-by-count":6,"title":["Emergency airway management in a Singapore centre: A registry study"],"prefix":"10.47102","volume":"50","author":[{"given":"Gene Wai Han","family":"Chan","sequence":"first","affiliation":[{"name":"National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chew Yian","family":"Chai","sequence":"additional","affiliation":[{"name":"National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joy Su-Yue","family":"Teo","sequence":"additional","affiliation":[{"name":"Ministry of Health Holdings Pte Ltd, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin Kai En","family":"Tjio","sequence":"additional","affiliation":[{"name":"Ministry of Health Holdings Pte Ltd, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mui Teng","family":"Chua","sequence":"additional","affiliation":[{"name":"National University Health System, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Calvin A III","family":"Brown","sequence":"additional","affiliation":[{"name":"Brigham and Women\u2019s Hospital, Boston, MA, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"26165","published-online":{"date-parts":[[2021,1,31]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Wong E, Ng YY. The difficult airway in the emergency department. Int J Emerg Med 2008;1:107-11.","DOI":"10.1007\/s12245-008-0030-6"},{"key":"ref1","unstructured":"Rao BK, Singh VK, Ray S, et al. Airway management in trauma. Indian J Crit Care Med 2004;8:98-105."},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Walls RM, Brown CA, Bair AE, et al. Emergency airway management: a multi-center report of 8937 emergency department intubations. J Emerg Med 2011;41:347-54.","DOI":"10.1016\/j.jemermed.2010.02.024"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Sakles JC, Laurin EG, Rantapaa AA, et al. Airway management in the emergency department: A one-year study of 610 tracheal intubations. Ann Emerg Med 1998;31:325-32.","DOI":"10.1016\/s0196-0644(98)70342-7"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Simpson J, Munro PT, Graham CA. Rapid sequence intubation in the emergency department: 5 year trends. Emerg Med J 2006;23:54-6.","DOI":"10.1136\/emj.2004.019398"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Mort TC. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts. Anesth Analg 2004;99:607-13.","DOI":"10.1213\/01.ane.0000122825.04923.15"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Sakles JC, Chiu S, Mosier J, et al. The importance of first pass success when performing orotracheal intubation in the emergency department. Acad Emerg Med 2013;20:71-8.","DOI":"10.1111\/acem.12055"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Ono Y, Kakamu T, Kikuchi H, et al. Expert-performed endotracheal intubation-related complications in trauma patients: incidence, possible risk factors, and outcomes in the prehospital setting and emergency department. Emerg Med Int 2018:5649476.","DOI":"10.1155\/2018\/5649476"},{"key":"ref8","unstructured":"April MD, Schauer SG, Brown Rd CA, et al. A 12-month descriptive analysis of emergency intubations at Brooke Army Medical Center: a National Emergency Airway Registry study. US Army Med Dep J 2018;98-104."},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"April MD, Arana A, Pallin DJ, et al. Emergency department intubation success with succinylcholine versus rocuronium: a National Emergency Airway Registry study. Ann Emerg Med 2018;72:645-53.","DOI":"10.1016\/j.annemergmed.2018.03.042"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Sagarin MJ, Barton ED, Chng YM, et al. Airway management by US and Canadian emergency medicine residents: A multicenter analysis of more than 6,000 endotracheal intubation attempts. Ann Emerg Med 2005;46:328-36.","DOI":"10.1016\/j.annemergmed.2005.01.009"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Low S, Chin MC, Deurenberg-Yap M. Review on epidemic of obesity. Ann Acad Med Sing 2009;38:57-9.","DOI":"10.47102\/annals-acadmedsg.V38N1p57"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Seidell JC, Halberstadt J. The global burden of obesity and the challenges of prevention. Ann Nutr Metab 2015;66:7-12.","DOI":"10.1159\/000375143"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Platts-Mills TF, Campagne D, Chinnock B, et al. A comparison of GlideScope video laryngoscopy versus direct laryngoscopy intubation in the emergency department. Acad Emerg Med 2009;16:866-71.","DOI":"10.1111\/j.1553-2712.2009.00492.x"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Yakushiji H, Goto T, Shirasaka W, et al. Associations of obesity with tracheal intubation success on first attempt and adverse events in the emergency department: An analysis of the multicenter prospective observational study in Japan. PLoS One 2018; 13;e0195938.","DOI":"10.1371\/journal.pone.0195938"},{"key":"ref15","doi-asserted-by":"crossref","unstructured":"Grant P, Newcombe M. Emergency management of the morbidly obese. Emerg Med Australas 2004; 16:309-17.","DOI":"10.1111\/j.1742-6723.2004.00614.x"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Juvin P, Lavaut E, Dupont H, et al. Difficult tracheal intubation is more common in obese than in lean patients. Anesth Analg 2003;97:595-600.","DOI":"10.1213\/01.ane.0000072547.75928.b0"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Wong E, Fong YT. Trauma airway experience by emergency physicians. Eur J Emerg Med 2003;10:209-12.","DOI":"10.1097\/00063110-200309000-00010"},{"key":"ref18","unstructured":"Malhotra R, Bautista MAC, M\u00fcller AM, et al. The aging of a young nation: population aging in Singapore. Gerontologist 2019;59:401-10."},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Johnson KN, Botros DB, Groban L, et al. Anatomic and physiopathologic changes affecting the airway of the elderly patient: implications for geriatric-focused airway management. Clin Interv Aging 2015;10:1925-34.","DOI":"10.2147\/cia.s93796"},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Kovacs G, Sowers N. Airway management in trauma. Emerg Med Clin North Am 2018;36:61-84.","DOI":"10.1016\/j.emc.2017.08.006"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Tayal VS, Riggs RW, Marx JA, et al. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med 1999;6:31-7.","DOI":"10.1111\/j.1553-2712.1999.tb00091.x"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Brown CA, Bair AE, Pallin DJ, et al. Techniques, success, and adverse events of emergency department adult intubations. Ann Emerg Med 2015;65:363-70.e1.","DOI":"10.1016\/j.annemergmed.2014.10.036"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Kovacs G, Law JA, Ross J, et al. Acute airway management in the emergency department by non-anesthesiologists. Can J Anaesth 2004;51:174-80.","DOI":"10.1007\/BF03018780"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Okubo M, Gibo K, Hagiwara Y, et al. The effectiveness of rapid sequence intubation (RSI) versus non-RSI in emergency department: an analysis of multicenter prospective observational study. Int J Emerg Med 2017;10:1.","DOI":"10.1186\/s12245-017-0129-8"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Kim C, Kang HG, Lim TH, et al. What factors affect the success rate of the first attempt at endotracheal intubation in emergency departments? Emerg Med J 2013;30:888-92.","DOI":"10.1136\/emermed-2012-201708"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Tran DTT, Newton EK, Mount VAH, et al. Rocuronium vs. succinylcholine for rapid sequence intubation: a Cochrane systematic review. Anaesthesia 2017;72:765-77.","DOI":"10.1111\/anae.13903"},{"key":"ref27","unstructured":"M a r t y n J A , R i c h t s f e l d M . S u c c i n y l c h o l i n e - i n d u c e d hyperkalemia in acquired pathologic states. Anesthesiology 2006;104:158-69."},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Chambers D, Paulden M, Paton F, et al. Sugammadex for the reversal of muscle relaxation in general anaesthesia: a systematic review and economic assessment. Health Technol Assess 2010;14:1-211.","DOI":"10.3310\/hta14390"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Chrimes N. The Vortex: a universal \u2018high-acuity implementation tool\u2019 for emergency airway management. Br J Anaesth 2016;117 Suppl 1:i20-7.","DOI":"10.1093\/bja\/aew175"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Lembersky O, Golz D, Kramer C, et al. Factors associated with post-intubation sedation after emergency department intubation: a report from the National Emergency Airway Registry. Am J Emerg Med 2020;38:466-70.","DOI":"10.1016\/j.ajem.2019.05.010"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Levine AI, DeMaria SJ. An updated report by the American Society of Anesthesiologists task force on management of the difficult airway: where is the aspiration risk assessment? Anesthesiology 2013;119:731-2.","DOI":"10.1097\/aln.0b013e31829e4b42"}],"container-title":["Annals of the Academy of Medicine, Singapore"],"original-title":[],"language":"en","deposited":{"date-parts":[[2022,12,17]],"date-time":"2022-12-17T12:50:19Z","timestamp":1671281419000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.annals.edu.sg\/pdf\/50VolNo1Jan2021\/V50N1p42.pdf"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,31]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2021,1,31]]},"published-print":{"date-parts":[[2021,1,31]]}},"URL":"https:\/\/doi.org\/10.47102\/annals-acadmedsg.2020331","relation":{},"ISSN":["0304-4602"],"issn-type":[{"value":"0304-4602","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,31]]}}}