This prospective registry study evaluated the incidence, practice patterns, and outcomes of emergency physician-performed awake tracheal intubations in a single academic, tertiary-care ED over 10 years (January 2015–January 2025), excluding sedation-only or dissociation-only intubations.
Of 1,213 ED intubations screened, 87 (7.2%) were awake intubations; 92% (n=80; 95% CI 86–98%) succeeded without a major adverse event. First-pass success was 71% (n=62), RSI conversion occurred in 6.9% (n=6), and critical hypoxemia, hypotension, and cardiac arrest each occurred in ≤3% of cases.
Single-center academic ED limits generalizability. The 10-year sample yielded only 87 cases, limiting statistical power. No comparator group (e.g., RSI in similar high-risk patients) was included to contextualize outcomes.
Emergency physicians can perform awake tracheal intubation with high success and low major adverse event rates in patients with anatomic or physiologic predictors of a difficult airway. Consider awake intubation as a viable ED strategy for high-risk airways, with RSI available as a backup in ~7% of cases.
Explore related topics
