Many emergency departments are now evaluating the quality of airway management, with the first-pass success rate being a widely used indicator of competence that has been linked to adverse event rates. The present study aimed to quantify adverse events related to endotracheal intubation in emergency departments, focusing on the first-pass success rate.We conducted a thorough search of MEDLINE, EMBASE, and PubMed using keywords such as "multiple intubation attempts," "intubation," "first-pass success," and "learning curve" to identify relevant research. Our search was further expanded to include references from the identified articles. We collected and assessed citations spanning a twenty-year period from 2000 to 2020, involving emergency airway management by both prehospital and in-hospital clinicians.Eight articles were included in the final review. Among them, three trials evaluated the impact of the number of intubation attempts on the complication rate, yielding odds ratios of 6.7 (n = 2284), 4.7 (n = 1903), and 4.5 (n = 2616). Multiple intubation attempts were found to increase the risk of complications, a finding supported by a 2004 analysis of 2833 airway management incidents. In this analysis, more than one intubation attempt was associated with a fivefold increase in the overall complication rate.First-pass success rates varied between 71% and 87.5% for prehospital physicians and between 60% and 97% for in-hospital physicians. Achieving first-pass success was shown to reduce problems and increase the likelihood of sufficient oxygenation. Conversely, multiple intubation attempts were correlated with a higher rate of unfavorable outcomes.
Key words: First pass success, emergency department, intubation
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