Tracheal Intubation in the Emergency Department of a Sub-Saharan Teaching Hospital:A One-Year Survey at Lagos University Teaching Hospital, Nigeria.

OBJECTIVES: To identify the indications for tracheal intubation in the emergency department of the Lagos University Teaching Hospital and problems encountered with the view to improve patient outcome. METHODS: A one-year prospective observational study of endotracheal intubation in the emergency room (ER) of the Lagos University Teaching Hospital. Data collected included indications, methods, success rates, use of drugs and complications of intubation. RESULTS: Ninety-four patients underwent endotracheal intubation. Indications included severe traumatic brain injury (58.5%) and traumatic brain injury with associated multiple injuries (10.6%). Anaesthetist registrars performed 73.9% of the intubations. Seventy seven patients (81.9%) were successfully intubated at the first attempt. No patient required a surgical airway due to failed intubation. The mean time from a decision to intubate to successful tracheal intubation was 129.90 ± 23.43 mins. 63.8% of the patients were intubated between 4 pm-8 am. Causes of delay in endotracheal intubation were non availability of skilled personnel (47.9%), non-availability of drugs (27%) and lack of oxygen (25%). Eighty-eight patients (93.6%) had complications at intubation: hypotension (42.5%), desaturation (34%), oesophageal intubation (2.1%), bronchial intubation (5.3%), cardiac arrest (2.1%). Post intubation complications included: blocked tube in 3 patients, accidental extubation in 4 patients and kinking of tube in 1 patient. Nine patients (9.6%) improved and were extubated. CONCLUSION: In this institution, the majority of Emergency department intubations were performed by anaesthetists after working hours with a very high success rate and a low rate of post-intubation serious complications. The delay in intubation should urgently be addressed to improve patient outcome.