Intubation quality assurance thresholds

Introduction: Quality assurance (QA) and continuous quality improvement (CQI) are valued activities within health-care organizations. Quality assurance indicators as guidelines for quality practice usually are established intuitively. The purpose of this study was to determine an appropriate threshold for successful intubation in patients transported by air and to examine factors impacting this success rate. Setting: Fifteen rotor-wing programs from across the United States participated. Method: The study was a prospective descriptive design. A total of 369 flight crew members agreed to participate, and intubations were attempted on 862 patients during the 12-month study. Results: Intubations were attempted on 862 patients and were successful in 788 (91.4%) of the patients. Of the patients not successfully intubated, 14 received supplemental oxygen only, 25 were supported with bagvalve-mask, 26 received a surgical cricothyroidotomy and for nine patients it was unknown what form of airway support was provided. Conclusion: Factors impacting successful intubation include cardiac arrest, use of neuromuscular blockade, use of sedatives and facial trauma. Data from the study support a threshold for successful intubation of between 90% and 95%.