Impact of a pre-procedural checklist on complications in emergency endotracheal intubation: a prospective cohort study

Document Type : Original Article

Authors

Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India -160012.

10.22038/psj.2025.86945.1466

Abstract

Introduction:
Emergency endotracheal intubation (ETI) is high-risk. Pre-procedural checklists may enhance safety, but evidence in emergency ETI is limited. This preliminary, exploratory study evaluated a checklist's impact on ETI complications and mortality.
 
Materials and Methods:
This prospective cohort study enrolled adult Emergency Department (ED) patients requiring emergency ETI (August 2021-December 2022). A control group (pre-checklist) was compared to an intervention group (post 12-point checklist implementation and training). Data on procedure-related complications and 24-hour mortality were collected and analyzed using relative risks.
 
Results:
131 patients (control n=68, checklist n=63) were included. The overall composite complication rate was similar (RR 1.01, p=0.90), potentially masking individual effects. Checklist use was associated with reduced aspiration (RR 0.36, p=0.045) but an unexpected increase in post-intubation hypoxia (RR 3.24, p=0.004); reasons, possibly procedural delays or altered team dynamics, require further investigation. Other individual complications and 24-hour mortality (RR 1.38, p=0.22) showed no significant differences.
 
Conclusion:
In this underpowered, preliminary, and exploratory study, a pre-procedural checklist did not significantly reduce overall ETI complications. The observed decrease in aspiration alongside increased hypoxia warrants cautious interpretation and underscores the complexity of checklist implementation in emergency airway management. Further research with larger sample sizes is crucial to optimize checklist design and confirm its impact on patient safety.

Keywords

Main Subjects

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Journal of Patient Safety & Quality Improvement
Volume 13, Issue 3
July 2025
Pages 153-161

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