Indications, techniques, success rates and complications of emergency airway management in Thuringian emergency departments: a prospective registry analysis

doi:10.5847/wjem.j.1920-8642.2026.033

Abstract

Abstract:

BACKGROUND: Airway management is a core competence in emergency medicine. International registries have described indications, techniques, and outcomes of endotracheal intubation, yet contemporary data from German emergency departments (EDs) are scarce. We conducted a multicenter prospective registry study in Thuringia, to characterize indications, techniques, success rates, and complications of ED intubations.

METHODS: From February 2023 to January 2024, six Thuringian EDs participated in a prospective observational registry (www.airwayregistry.eu). All consecutive intubations were documented anonymously using a standardized digital form. Demographics, indications, methods, equipment, operator characteristics, first pass success (FPS), overall success, and complications were captured. Descriptive statistics were used.

RESULTS: We analyzed 117 intubations (63.2% male; mean age 68.4 years, range 2-98 years). FPS was 88.9% (104/117), second pass success was 4.3% and third pass success was 6.8%; overall success was 100%. Rapid sequence intubation (RSI) was used in 77.8% of intubations and delayed sequence intubation (DSI) in 21.4%; 10.3% were performed without medication. Direct laryngoscopy (DL) was used in 65.0% and videolaryngoscopy (VL) in 34.2%. FPS was higher with VL than DL (92.5% vs. 88.2%). The most common indications were cardiopulmonary resuscitation (14.5%) and stroke/ischemia (13.7%); intracranial hemorrhage accounted for 13.7%. Complications occurred in 39% of cases, most frequently hypotension (23.9%) and catecholamine requirement (12.0%). A difficult airway was anticipated in 30.8%.

CONCLUSION: In this multicenter snapshot from German EDs, overall intubation success was high but complications—especially peri-intubation hypotension—were common. VL yielded higher FPS yet was used less frequently than DL. Standardized protocols, hemodynamic optimization, and broader VL adoption may improve safety and performance.

Key words: Emergency airway management, Endotracheal intubation, Videolaryngoscopy, Airway registry, Emergency department

Nelly Richter, Frank Bloos, Christian Hohenstein. Indications, techniques, success rates and complications of emergency airway management in Thuringian emergency departments: a prospective registry analysis[J]. World Journal of Emergency Medicine, 2026, 17(2): 146-153.

Figures/Tables 5

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Characteristic	Value
Age, years, mean ± standard deviation	68.4 ± 15.2
Male, n (%)	74 (63.2%)
Female, n (%)	43 (36.8%)
Day shifts, n (%)	105 (89.7%)
Night shifts, n (%)	12 (10.3%)
Difficult airway anticipated, n (%)	36 (30.8%)
Apneic oxygenation used, n (%)	43 (36.8%)

Indication	n (%)
Cardiopulmonary resuscitation	17 (14.5%)
Intracranial hemorrhage	16 (13.7%)
Stroke/ischemia	16 (13.7%)
Sepsis	10 (8.5%)
COPD/asthma	10 (8.5%)
Other internal reason	9 (7.7%)
Myocardial infarction	8 (6.8%)
Other neurological reason	7 (6.0%)
Pneumonia	7 (6.0%)
Gastrointestinal bleeding	6 (5.1%)
Heart failure	6 (5.1%)
Traumatic brain injury	6 (5.1%)
Respiratory failure	4 (3.4%)
Pulmonary embolism	3 (2.6%)
Airway obstruction	2 (1.7%)
Intoxication without LOC	1 (0.9%)
Unknown neurological cause	1 (0.9%)
Polytrauma	1 (0.9%)

Method/equipment	n (%)
Rapid sequence intubation (RSI)	91 (77.8%)
Delayed sequence intubation (DSI)	25 (21.4%)
No medication	12 (10.3%)
Direct laryngoscopy (DL)	76 (65.0%)
Videolaryngoscopy (VL)	40 (34.2%)
Other device	1 (0.9%)

Operator rank and specialty	n (%)
Rank
Resident	21 (17.9%)
Specialist	27 (23.1%)
Senior physician	53 (45.3%)
Chief physician	16 (13.7%)
Specialty
Anesthesiology	93 (79.5%)
Surgery	13 (11.1%)
Internal medicine	9 (7.7%)
Neurology	1 (0.9%)
Missing / not recorded	1 (0.9%)
Subspecialty EM	35 (29.9%)
Core Team EM	39 (33.3%)

Complication	n (%)
Hypotension	28 (23.9%)
Catecholamine requirement	14 (12.0%)
Hypoxia	10 (8.5%)
Esophageal intubation	6 (5.1%)
Aspiration	4 (3.4%)
Upper airway injury	2 (1.7%)
Cardiopulmonary resuscitation	0 (0%)
Other	12 (10.3%)