Podcast 1010: First Pass Intubation Success

Contributor: Travis Barlock, MD

Educational Pearls:

First-pass success is critical to limit complications from apnea, hypoxia, and airway trauma.

Complication rate for patients intubated on the first pass is 14%

Complication rates increase to 47% after two attempts, 64% after three, and 71% after the fourth attempt

How to improve likelihood of first-pass success:

Use Video laryngoscopy (VL). VL increases chance of first-pass success to 85% from 71%

Use a bougie, especially in patients with anatomically difficult or otherwise obstructed airways. The BEAM study cites a success rate in these patients of 96% with a bougie, compared to 82% without

Use a Checklist mnemonic (SOAPME)

Suction – On, ready, and within reach

Oxygen – Patient is preoxygenated

Adjuncts – Oral/nasal adjuncts and BVM ready