DESCRIPTIVE STUDY OF ENDOTRACHEAL INTUBATION PRACTICES AT THE COLONIAL WAR MEMORIAL HOSPITAL EMERGENCY DEPARTMENT, SUVA, FIJI.

Introduction
Emergency medicine is the newest speciality in Fiji established in 2012. Performing endotracheal intubation has become routine at the CWM ED. There have been no studies to date looking at ED first pass success rate locally. This study aimed to describe the logistics of endotracheal intubation, first pass success rate, complications and predictive factors for FPS.
Methodology
This was a descriptive study with prospective data collection and retrospective analysis carried out over a 12-month period from January to December 2019 at the CWM Emergency Department. Data was collected from the CWM ED Airway Audit form and analyzed using Microsoft Excel and JASP for descriptive and logistical regression analysis.
Results
102 intubations were recorded over the 12-month period. The overall FPS rate was 84.3.%. The complication rate was 33%. 82% of patients were intubated for medical reasons (respiratory failure and cardiac arrest). RSI with ketamine and suxamethonium was the preferred method of intubation. The difficult intubation rate was 0.9%. Use of apnoeic oxygenation (OR 1.027 p=0.974 95% CI 0.205 to 5.141), being experienced intubation (OR 1.72 p=0.263 95% CI 0.53 to 5.58), use of RSI checklist (OR 1.458 p=0.556 95% CI 0.416 to 5.116) and the RSI method (OR 1.125 p=0.890 95% CI 0.212 to 5.982) were associated with FPS. Obtaining a grade III (OR 0.049 p=0.004 95% CI 0.006 to 0.386) or grade IV (OR 0.025 p=0.001 95% CI 0.003 to 0.241) during direct laryngoscopy and developing one or more complications (OR 0.115 p<0.01 95% CI 0.033 to 0.392) were associated with reduced chance of FPS.
Conclusion
The CWM ED FPS rate is at 84.3% on par with most studies from the developed world but with a higher complication rate of 33%. The majority of intubated patients were sick with one or more co-morbidities and unstable vital signs. These results emphasize the importance of the doctrine of FPS for ED intubations.