Center for Bioethics Harvard Medical School Minneapolis, Minnesota, United States
Background: Endotracheal intubation is one complex emergency procedure performed by emergency medical services (EMS) for the purpose of airway management during cardiac arrest. Failed intubations have significant potential to negatively affect patient outcomes, so identifying disparities in intubation success rates is of great epidemiological and clinical importance.
Objective: Various racial and ethnic disparities in the context of cardiac arrest have been previously identified, however, almost no research has examined whether intubation success rates vary based on patient race/ethnicity.
Design/Methods: We examined a nationwide repository of EMS runs in the United States (NEMSIS). Inclusion criteria was an out-of-hospital cardiac arrest in a pediatric patient (0-17 years) between 2017 and 2019 where an endotracheal intubation was performed. Examining intubations only performed within the context of cardiac arrest allows us to control for the varying circumstances in which intubations are deployed, since the indication for all intubations in this cohort is largely the same.
Results: A total of 3,574 intubations met inclusion criteria. The majority (56.16%) were conducted in White patients, followed by Black or African American patients (30.44%) and Hispanic or Latino patients (13.40%). Intubation success rate was comparable in White patients (68.31%) and Hispanic or Latino patients (67.85%) but was significantly lower in Black or African American patients (63.97%) (pConclusion(s): Considering other forms of cardiac arrest disparities, these results are both alarming yet also unsurprising. There are a number of possible explanations for these results, including system-level explanations and patient-level explanations. At the system level, EMS agencies may vary in the use of assistive technologies shown to improve intubation success (eg. video laryngoscopy). Furthermore, clinicians in some EMS systems may have more opportunities to train airway management skills as others (eg. partnerships with hospitals). There are also patient-level explanations for the trends we observed. For instance, certain patients may have poorer baseline health, making successful intubation more difficult. Further studies should deeply examine disparities in intubation success rates with the aim of precisely identifying the causes behind these disparities and developing solutions on how to rectify them. Aditya Shekhar CV (Short) – APA.pdf
