How many attempts to intubate?
Its hard to give up procedure if you are failing it !!. For intubation, ASA (American Society of Anesthesiologists) recommends to limit laryngoscopic attempts to three. Dr. Thomas C. Mort from Hartford Hospital, CT entered 2833 Critically-ill patients, suffering from cardiovascular, pulmonary, metabolic, neurologic, or trauma-related deterioration into an emergency intubation quality improvement database. Data confirmed that the number of laryngoscopic attempts were directly proportional with the incidence of airway and hemodynamic adverse events (more than 2 attempts).
- incidence of hypoxemia went from 11.8% to 70%,
- incidence of regurgitation of gastric contents went from 1.9% to 22%,
- incidence of aspiration of gastric contents went from 0.8% to 13%,
- incidence of bradycardia went from 1.6% to 21%, and
- incidence of cardiac arrest went from 0.7% to 11%
Call for help !! and remember, to limit intubation attempts to 3, unless untill you are trained to deal with 'difficult intubations'.
References: click to get abstract/article
1. Emergency tracheal intubation: complications associated with repeated laryngoscopic attempts - Anesth Analg 2004;99:607-613