Resuscitation 83 (2012) 428–433 Contents lists available at SciVerse ScienceDirect Resuscitation j ourna l h o me pag e: www. elsevier.com/locate/resuscitation Clinical paper Emergency airway management in Japan: Interim analysis of a multi-center prospective observational study , Kohei Hasegawa a,b,* , Yusuke Hagiwara c , Takuyo Chiba d , Hiroko Watase e , Ron M. Walls a , David F.M. Brown b , Calvin A. Brown III a , On behalf of the Japanese Emergency Medicine Research Alliance a Department of Emergency Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA b Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA c Department of Emergency Medicine, Kawaguchi Municipal Medical Center, 180 Nishiaraijuku, Kawaguchi, Saitama 333-0833, Japan d Department of Emergency Medicine, Obama Municipal Hospital, 2-2 Ootemachi, Obama, Fukui 917-8567, Japan e Department of Public Health and Preventive Medicine, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239, USA a r t i c l e i n f o Article history: Received 21 June 2011 Received in revised form 16 November 2011 Accepted 21 November 2011 Keywords: Airway management Intubation Emergency department Rapid sequence intubation Japan Practice variation a b s t r a c t Objectives: Emergency medicine is increasingly recognized as a medical specialty in Japan. However, comprehensive studies evaluating emergency airway management practice are lacking. We describe emergency department (ED) airway management using a large multi-center registry. Methods: We formed the Japanese Emergency Airway Network, a consortium of 10 academic and com- munity medical centers in Japan, and prospectively collected data on ED intubations from April 2010 to February 2011. All patients undergoing emergency intubation were eligible for inclusion. Data were entered in real time by the intubator using a standardized data form. Variables included patient’s age, sex, weight, indication for intubation, methods of intubation, drugs, level of training and specialty of the intubator, number of attempts, success or failure, and adverse events. We present descriptive data as proportions with 95% confidence intervals. Results: We recorded 1486 intubations (compliance rate 99%). Intubation was ultimately successful in 99.7%. The initial method of intubation varied substantially among the hospitals, including rapid sequence intubation (0–79%), sedation without paralysis (4–88%), paralysis without sedation (0–18%), and oral without medication (12–67%), in non-cardiac arrest encounters. Success rates in first and ≤3 attempts ranged from 40 to 83% and from 74 to 100%, respectively. The overall adverse event rate was 11%, without significant difference by the method used. Conclusions: In this multi-center study characterizing ED airway management across Japan, we observed a high overall success rate but a high degree of variation among hospitals in the methods of intubation and success rates. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Airway management by emergency physicians is becoming more common in Japan as the specialty continues to grow yet lit- tle is known about intubation practices in this country. One study suggests that emergency physicians in Japan still resist the adminis-  A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.11.027.  Abstract was presented at the Mediterranean Emergency Medicine Congress Annual Meeting, Kos, Greece, September 2011. * Corresponding author at: Founders 114, Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA 02114, USA. Tel.: +1 857 350 6519. E-mail addresses: khasegawa1@partners.org, koheihasegawamd@gmail.com (K. Hasegawa). tration of rapid sequence intubation drugs, 1 although it is accepted practice in emergency physicians in North America. 2–7 Several pre- vious smaller studies in Japan have reported intubation methods and success rates within single institutions, but comprehensive large multi-center studies are lacking. 8–10 Although intubation is frequently performed in EDs in Japan, only limited data describe the patients, techniques or providers involved in these procedures. Surveillance of criti- cal emergency procedures is essential for reasons of policy, training, and clinical practice development. Our goal was to describe emergency intubation indications, methods used for intubation, devices and medication regimens used, operator char- acteristics, success rates by method and by encounter, and adverse event rates using a multi-center registry model in Japan. 0300-9572/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.resuscitation.2011.11.027