{"version":1,"type":"rich","provider_name":"Libsyn","provider_url":"https:\/\/www.libsyn.com","height":90,"width":600,"title":"Podcast 1010: First Pass Intubation Success","description":"Contributor: Travis Barlock, MD Educational Pearls: &amp;nbsp; First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.&amp;nbsp;   Complication rate for patients intubated on the first pass is 14%   Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt   &amp;nbsp; How to improve likelihood of first-pass success:   Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71%   Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without   Use a Checklist mnemonic (SOAPME)    Suction \u2013 On, ready, and within reach   Oxygen \u2013 Patient is preoxygenated   Adjuncts \u2013 Oral\/nasal adjuncts and BVM ready   Positioning - Patient positioned properly; consider obesity, using semi-Fowler\/head-up positioning   Medications \u2013 Rapid sequence intubation (RSI), sedation, vasopressor, and other medications prepared as necessary   Equipment \u2013 Laryngoscope (blade), tube, bougie\/stylet, syringe, scalpel\/cric kit, others ready as necessary      References   Sakles, J.C., Chiu, S., Mosier, J., Walker, C. and Stolz, U. (2013), The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department. Acad Emerg Med, 20: 71-78. https:\/\/doi.org\/10.1111\/acem.12055   Prekker ME, Driver BE, Trent SA, et al. Video versus Direct Laryngoscopy for Tracheal Intubation of Critically Ill Adults. New England Journal of Medicine. 2023;389(5). doi:https:\/\/doi.org\/10.1056\/nejmoa2301601   Driver BE, Prekker ME, Klein LR, et al. Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients With Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. JAMA. 2018;319(21):2179\u20132189. doi:10.1001\/jama.2018.6496   \u200cTurner JS, Bucca AW, Propst SL, et al. Association of Checklist Use in Endotracheal Intubation With Clinically Important Outcomes: A Systematic Review and Meta-analysis. JAMA Netw Open. 2020;3(7):e209278. doi:10.1001\/jamanetworkopen.2020.9278   Turner, Joseph S et al. \u201cFeasibility of&amp;nbsp; upright patient positioning and intubation success rates At two academic EDs.\u201d The American journal of emergency medicine vol. 35,7 (2017): 986-992. doi:10.1016\/j.ajem.2017.02.011   &amp;nbsp; Summarized by Sam Pahl | Edited by Sam Pahl &amp;amp; Ahmed Abdel-Hafiz, NREMT-P &amp;nbsp; Donate: https:\/\/emergencymedicalminute.org\/donate\/ &amp;nbsp; Join our mailing list: http:\/\/eepurl.com\/c9ouHf &amp;nbsp; ","author_name":"Emergency Medical Minute","author_url":"https:\/\/www.emergencymedicalminute.com","html":"<iframe title=\"Libsyn Player\" style=\"border: none\" src=\"\/\/html5-player.libsyn.com\/embed\/episode\/id\/41853870\/height\/90\/theme\/custom\/thumbnail\/yes\/direction\/forward\/render-playlist\/no\/custom-color\/fa102a\/\" height=\"90\" width=\"600\" scrolling=\"no\"  allowfullscreen webkitallowfullscreen mozallowfullscreen oallowfullscreen msallowfullscreen><\/iframe>","thumbnail_url":"https:\/\/assets.libsyn.com\/secure\/item\/41853870"}