Incidence and Outcomes of Emergency Physician-Performed Awake Intubations: A Report From the Airway Interventions Registry and Observational Database

Ann Emerg Med. 2026 Jul 6:S0196-0644(26)00371-9. doi: 10.1016/j.annemergmed.2026.06.007. Online ahead of print.

ABSTRACT

STUDY OBJECTIVE: To determine the incidence, practice patterns, and outcomes of emergency physician-performed awake tracheal intubations in a tertiary-care emergency department (ED).

METHODS: In this study of the prospective Airway Interventions Registry and Observational database, we screened all intubations performed at an academic, tertiary-care ED between January 1, 2015, and January 1, 2025, for adults undergoing first-attempt awake tracheal intubation by an emergency physician. We excluded patients undergoing sedation-only or dissociation-only intubation. Our primary outcome was overall success without any of the following major adverse events: critical hypoxemia (SpO₂<80%), critical hypotension (systolic blood pressure<65 mmHg), or cardiac arrest. Our secondary outcomes were the frequencies of first-pass success, adverse events, and conversion to rapid sequence intubation.

RESULTS: Among the 1,213 ED intubations screened during the 10-year study period, 87 (7.2%) were emergency physician-performed awake intubations. Most patients undergoing awake intubation had anatomic (80%) or physiologic (87%) predictors of difficulty, or both (68%). Success without a major adverse event occurred in 80 (92%; 95% confidence interval 86% to 98%) patients. There was first-pass success in 62 (71%) and rapid sequence intubation conversion in 6 (6.9%) patients. Critical hypoxemia, critical hypotension, and cardiac arrest occurred in 3%, 2%, and 2%, respectively.

CONCLUSION: In this preliminary single-center study, emergency physicians performed awake intubation with relatively high incidence, high overall success, and low rates of major adverse events.

PMID:42405912 | DOI:10.1016/j.annemergmed.2026.06.007