• Emily M Hayden, Daniel J Pallin, Susan R Wilcox, James A Gordon, Jestin N Carlson, Ron M Walls, Calvin A Brown, and National Emergency Airway Registry (NEAR) III Investigators.
• Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA.
• Acad Emerg Med. 2018 Nov 1; 25 (11): 1263-1267.

ObjectiveThe objective was to describe the frequency, indications, and outcomes of flexible fiberoptic intubations (FFI) performed in the emergency department (ED).MethodsFrom the National Emergency Airway Registry (NEAR), we identified all encounters from July 1, 2002, through December 31, 2012, with the use of FFI. We determined patient, provider, and intubation characteristics; success and failure rates; and modes of intubation rescue.ResultsAmong 17,910 intubations of patients > 15 years old at 13 EDs, FFI was used in 204 cases (1.1%, 95% confidence interval [CI] = 0.26%-2.0%). FFI was the first method chosen (primary FFI) in 180 encounters (1%, 95% CI = 0.2%-1.8%). The most common indication for FFI was airway obstruction (36.1%, 95% CI = 24.6%-47.7%). For primary FFI, first-attempt intubation success was 51.1% (95% CI = 43.6%-58.6%), and overall intubation success with FFI was 74.3% (95% CI = 65.7%-82.9%). FFI was used as a rescue airway strategy in 24 cases (0.1% of all encounters) and was successful in 17 of those (70.8%, 95% CI = 65.4%-85.2%).ConclusionsEmergency department FFI is uncommon and typically used as a nonsurgical alternative for airway obstruction. First-attempt ED FFI is successful in half of cases and in two-thirds of rescue attempts. These data provide an important baseline to help better characterize the nature of FFI as a rare critical procedure in the ED and offer an empiric basis for ongoing discussions on the optimal role of FFI in ED training and practice.© 2018 by the Society for Academic Emergency Medicine.

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