Fewer tracheal intubation attempts are associated with improved neurologically intact survival following out-of-hospital cardiac arrest

David L. Murphy, Natalie E. Bulger, Brenna M. Harrington, Jillian A. Skerchak, Catherine R. Counts, Andrew J. Latimer, Betty Y. Yang, Charles Maynard, Thomas D. Rea, Michael R. Sayre

Research output: Contribution to journalArticlepeer-review

11 Scopus citations


Background: International guidelines emphasize advanced airway management during out-of-hospital cardiac arrest (OHCA). We hypothesized that increasing endotracheal intubation attempts during OHCA were associated with a lower likelihood of favorable neurologic survival at discharge. Methods: This retrospective, observational cohort evaluated the relationship between number of intubation attempts and favorable neurologic survival among non-traumatic OHCA patients receiving cardiopulmonary resuscitation (CPR) from January 1, 2015–June 30, 2019 in a large urban emergency medical services (EMS) system. Favorable neurologic status at hospital discharge was defined as a Cerebral Performance Category score of 1 or 2. Multivariable logistic regression, adjusted for age, sex, witness status, bystander CPR, initial rhythm, and time of EMS arrival, was performed using the number of attempts as a continuous variable. Results: Over 54 months, 1205 patients were included. Intubation attempts per case were 1 = 757(63%), 2 = 279(23%), 3 = 116(10%), ≥4 = 49(4%), and missing/unknown in 4(<1%). The mean (SD) time interval from paramedic arrival to intubation increased with the number of attempts: 1 = 4.9(2.4) min, 2 = 8.0(2.9) min, 3 = 10.9(3.3) min, and ≥4 = 15.5(4.4) min. Final advanced airway techniques employed were endotracheal intubation (97%), supraglottic devices (3%), and cricothyrotomy (<1%). Favorable neurologic outcome declined with each additional attempt: 11% with 1 attempt, 4% with 2 attempts, 3% with 3 attempts, and 2% with 4 or more attempts (AOR = 0.41, 95% CI 0.25–0.68). Conclusions: Increasing number of intubation attempts during OHCA resuscitation was associated with lower likelihood of favorable neurologic outcome.

Original languageEnglish (US)
Pages (from-to)289-296
Number of pages8
StatePublished - Oct 2021
Externally publishedYes


  • Airway management
  • Cardiopulmonary resuscitation
  • Emergency medical services
  • Emergency medical technicians
  • Heart arrest
  • Intratracheal
  • Intubation

ASJC Scopus subject areas

  • Emergency Medicine
  • Emergency
  • Cardiology and Cardiovascular Medicine


Dive into the research topics of 'Fewer tracheal intubation attempts are associated with improved neurologically intact survival following out-of-hospital cardiac arrest'. Together they form a unique fingerprint.

Cite this