How to Reduce Multiple Attempt Intubations and Improve Outcomes

Benn Horrisberger

Publish Date:

January 25, 2023

Endotracheal intubation is a necessary resuscitative procedure in the emergency setting to secure a patient's airway and provide oxygenation and ventilation. There are multiple indications for endotracheal intubation, including questionable airway patency, poor respiratory drive, hypoxia, and hypercarbia. Regardless of the indication, the goal of endotracheal intubation in the emergency setting is to secure the patient's airway and obtain first-pass success. First-pass success is a widely recognized goal of emergency airway management. However, it often takes more than one attempt to intubate a patient successfully. In fact, it often takes multiple attempts. 

The Number of Tracheal Intubation Attempts Matters 

Studies have shown that multiple intubations have potentially severe clinical consequences. For instance, a prospective multi-institutional pediatric observational study published in BMC Pediatrics set out to determine the association between the number of tracheal intubation attempts and severe desaturation and other adverse events in critically ill children with acute respiratory failure. The authors found that the number of attempts was associated with desaturations and increased occurrence of adverse events. In other words, the more attempts it took to secure the airway, the more adverse events and oxygen desaturation occurred. 

Multiple failed intubation attempts are also associated with decreased success rates on the first rescue intubation. A study published in the Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine aimed to find out if preceding multiple failed intubation attempts resulted in a decreased success rate on the first rescue intubation in emergency departments. Researchers found that as the number of preceding failed intubation attempts increased, the success rate on the first rescue intubation attempt declined.

Studies have also concluded that repeated intubation attempts increase the risk of airway obstruction, resulting in severe airway complications. This is why major difficult airway guidelines unanimously recommend avoiding repeated attempts. 

Improving First-Pass Success is Critical 

Anesthesiologists, emergency room physicians, and other clinicians frequently tasked with airway management know how critical it is to improve first-pass success rates in patients with challenging airways. A recent survey of over 250 medical professionals revealed that 60 percent would be interested in exploring medical device innovations to help reduce multiple intubation attempts. 

Intubating critically ill patients is especially challenging and is considered a high-risk procedure. Airway visualization and tracheal tube placement often become difficult due to patient-related factors, leading to multiple failed intubation attempts and an increased risk of complications. In addition, operator-related factors such as experience, device selection, and pharmacologic choices can also impact the chances of successful intubation on the first attempt. 

Reduce Multiple Intubation Attempts To Improve Outcomes

Although several strategies exist to improve first-attempt intubation success in critically ill patients, none are 100 percent effective. For instance, doctors are encouraged to perform pre-intubation assessments to predict difficult airways. However, the problems are that they all focus on the anatomic features that make visualization of the glottic inlet difficult and are often challenging to perform. 

Device selection is another strategy clinicians revert to when faced with difficult airway cases. Several devices are available for airway management, including direct laryngoscopes, indirect laryngoscopes (optical or video laryngoscopes), flexible fiberoptic, and supraglottic devices. While many can help improve first-pass success rates, user experience level affects their clinical usefulness. 

Improve First-Pass Success with QuickSteer

Based on the lack of 100 percent effective strategies to avoid multiple intubations, clinicians have been seeking innovative intubation technologies to manage difficult airways safely, effectively, and with confidence. Our survey found that some have been looking for an articulating stylet for years, while others have been searching for a device that reduces the need for multiple modalities when encountering a difficult airway. 

It is important to note that multiple attempts can occur with the same device or by using different devices. The longer it takes to successfully intubate a patient, the more likely it is that bagging the patient (or putting them on a ventilator) becomes necessary.  QuickSteer not only helps with difficult airway management, but also saves valuable time by improving first-pass success, and therefore reducing the need for bagging a patient at all.

Learn More About QuickSteer

QuickSteer is the latest innovation in airway management designed to reduce overall intubation time and improve first-pass success rate in patients with difficult airways. Thanks to its intuitive, articulating, and atraumatic soft tip, this innovative device eliminates the impact of user skill or experience, allowing physicians to place the intubation aid tip through the vocal cords faster than alternative products. 

Watch this video to see QuickSteer™ in action. 

Ready to learn more? Connect with a customer service team member by calling 763.330.2162 or emailing

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