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An analysis of the NEAR database demonstrated a lower first-pass success rate of 89.2% for patients with anatomically difficult airways (ADA) compared to 93.7% in the control group. First-pass success for physiologic difficult airways (PDA) was 92.9% and fell to 87.4% for those with both ADA/PDA.
Rain is wet and first-pass success for anatomically difficult airways
This retrospective analysis of the NEAR database included 13,938 patients over the age of 14 who underwent rapid sequence intubation (RSI) in the emergency department (ED). 3664 were classified as ADA, 1304 as PDA, 7103 as both PDA and ADA, and 1867 as neither. Compared to the control group, those with ADA were almost half as likely to have first pass success (aOR 0.53, 95%CI 0.40–0.68), but the group with lowest first-pass success were those with both ADA/PDA (aOR 0.44, 95%CI 0.34–0.56). Importantly, in those with only PDA, there was no association with lower rate of first-pass success. The rate of peri-intubation cardiac arrest was the same in those with PDA and both ADA/PDA at 1.5%. Specifically, the authors include a great discussion of how obesity can be both anatomically difficult (poor view) and physiologic difficult (post-intubation hypoxemia) (check out supplemental tables 2 and 3).
Source
First-Attempt Success Between Anatomically and Physiologically Difficult Airways in the National Emergency Airway Registry. Anesth Analg. 2024;138(6):1249-1259. doi:10.1213/ANE.0000000000006828
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