Skip to content

Optimize for First Pass Success

NextGen Learning To Elevate Your Airway Practice

IntroductionDefinitionKey Findings
Bottom LineOptimize FPSWhat’s Next

Definition

What is term, first-pass success, or (FPS) that is so often cited as a metric for high-quality intubation? Start by visiting our Critical Language Compendium and learn more about this important airway term.

The Evidence

“The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department” by Sakles et al. investigates the relationship between first pass success (FPS) during orotracheal intubation and the incidence of adverse events (AEs) in an emergency department (ED) setting. Conducted over four years, the study analyzed 1,828 orotracheal intubations performed in an academic emergency department.(pmc.ncbi.nlm.nih.gov)

Key Findings

  • First Pass Success Rate: The overall FPS rate was 72.9%, with 1,333 out of 1,828 intubations successful on the first attempt.
  • Incidence of Adverse Events:
  • Patients intubated successfully on the first attempt experienced AEs in 14.2% of cases.
  • The incidence of AEs increased with the number of attempts:
    • Two attempts: 47.2%
    • Three attempts: 63.6%
    • Four or more attempts: 70.6%
  • Specific Adverse Events:
    • Oxygen Desaturation: Occurred in 9.2% of first-attempt successes and increased to 37.8% in cases requiring multiple attempts.
    • Aspiration: Observed in 0.8% of first-attempt successes, rising to 5.9% with multiple attempts.
    • Esophageal Intubation: No cases were reported in first-attempt successes, but the incidence was 15.8% in multiple-attempt scenarios.
  • Risk Analysis: After adjusting for potential confounders, requiring more than one intubation attempt was a significant predictor of experiencing one or more AEs, with an adjusted odds ratio of 7.52.

The more you try, the worse things get

the publication.

The Importance of First Pass Success When Performing Orotracheal Intubation in the Emergency Department – John C. Sakles, MD, Stephen Chiu, MD, Jarrod Mosier, MD, Corrine Walker, MD, and Uwe Stolz, PhD, MPH

nihms705574-3Download

The Bottom Line

Achieving first-pass success during orotracheal intubation in the ED is associated with fewer adverse events. The likelihood of encountering complications increases substantially with each additional intubation attempt. These findings underscore the importance of maximizing first-pass success to enhance patient safety during emergency airway management.

Optimize Your FPS

5 Things You Can Do to Improve Your FPS

  • Preparation is key: Preoxygenate, assess the airway and have backup plans.
  • Optimize the first attempt: by Using correct positioning (sniffing position) and “bed up, head elevated” (BUHE).
  • Use appropriate medications: Give suitable sedation and paralysis to optimize intubating conditions.
  • Choose the right tools: Video laryngoscopy, bougie & stylet use, and hyperangulated video laryngoscopy can improve FPS.
  • Practice and train: Regular airway training improves FPS rates over time.

The Key Take Home

What’s Next

Find Or Click Me

Nice work—you’re through this section! To keep going, scan the QR code on the physical poster at the next station in our pop-up training space to access the next set of digital content. Prefer to stay online? Just click the poster image here to continue your journey.

home page

Back to Top