Improving first-pass success rates during emergency intubation at an academic emergency department: a quality improvement initiative.

BACKGROUND: Airway management is a high-stakes procedure in emergency medicine. Continuously monitoring this procedure allows performance improvement while revealing safety issues. We instituted a quality improvement initiative in the emergency department to improve first-pass success rates in the emergency department. METHODS: This was a quality improvement initiative at an academic emergency department from 2018 to 2020. We developed a rapid sequence intubation guideline for procedure standardization and introduced an intubation procedure note for performance monitoring. Data were entered directly by the primary physician and nurse during intubation. The quality improvement team thereafter collected the data retrospectively and entered into a local airway database. More importantly, we introduced a culture of quality improvement and safety in airway management via regular education and feedback. RESULTS: We included a total of 146 intubations. The first-pass success rate started at 57.1% and increased to 80.0% during the study period (P < 0.01). Fifty-six percent were male, and the mean age (±SD) was 55.56 (±17.64). Video laryngoscopy was used in 101 (69.2%) patients, while direct laryngoscopy was used in only 44 (30.8%) patients. A logistic regression analysis was conducted to determine the independent factors associated with first-pass success. These factors included the use of video laryngoscopy (odds ratio (OR) 2.47 95% confidence interval (95% CI) [1.62-3.76]) (adjusted OR 3.87 [1.13-13.23]) and good Cormack-Lehane views (grades 1-2) (OR 2.71 95% CI [1.74-4.20]) (adjusted OR 7.88 [2.43-25.53]). CONCLUSION: Our study shows that implementing and maintaining an airway quality improvement program improves first-pass intubation success. Moreover, the use of video laryngoscopy and obtaining good Cormack-Lehane views (grades 1-2) are independently associated with improved first-pass success.

Prevalence of Gastroesophageal Reflux Disease (GERD) Among Electronic Cigarette-Smoking University Students in Jeddah, Saudi Arabia.

Background Gastroesophageal reflux disease (GERD) is one of the most common gastrointestinal tract diseases. Although there is a strong association between smoking and GERD, it is poorly understood until now. Electronic cigarettes (E-cigarettes) are widely used nowadays. So, our study aimed to investigate the prevalence of GERD among all Jeddah university students and its relation to E-cigarette smoking. Methodology A cross-sectional study was conducted among university students of all specialties in Jeddah, Saudi Arabia, using an online questionnaire to collect data distributed in a Google Form (Google LLC, Mountain View, California, United States) from August to November 2022. Results This study included 397 students, 36.5% of whom were from 18 to 20 years old, and the majority were females (69.3%). Of the participants, 43.8% were non-smokers, 13.1% were ex-smokers, and 43.1% currently smoked; of the last, 13.6% smoked tobacco cigarettes, 17.6% smoked hookah, and 35% were current E-cigarette smokers. The study found that among the participants, 19.9% had GERD based on the GerdQ, with females having a significantly higher percentage of GERD. A weak association was found between the prevalence of GERD and smoking cigarettes (p=0.49), hookah (p=0.988 ), and E-cigarettes (p=0.788 ) but this could be attributed to the high BMI. Conclusion E-cigarette smoking is more prevalent among university students in Jeddah than traditional cigarettes or hookah. However, there was no statistically significant link between E-cigarette smoking and GERD. High BMI could be a superadded factor.