Emergency medicine is increasingly recognized as a medical specialty in Japan.

1. Rapid Sequence Intubation (RSI) versus Non-RSI in Emergency Department (ED) : Multi-Center Prospective Observational Study in Japan Masashi Okubo 1,4Kohei Hasegawa2,4 Yusuke Hagiwara3,4 1Okinawa Chubu Hospital 2Massachusetts General Hospital 3Kawaguchi Medical Center 4Japanese Emergency Medicine Research Alliance The use of RSI for ED intubation is highly variable among sites. The application rate of RSI for Non-Cardiac Arrest ED intubation varied from 0.9% to 79.3%. INTRODUCTION Emergency medicine is increasingly recognized as a medical specialty in Japan. However comprehensive studies evaluating current practice of ED airway management are lacking. Many emergency physicians in Japan still experience resistance regarding RSI. Comparing RSI with Non-RSI on 1st attempt (Excluding Cardiac Arrest) OBJECTIVES We compared RSI with Non-RSI (intubation with sedation only, neuromuscular blockade only, without medication) in terms of success and complication rate using a multi-center registry in Japan. Success rate of RSI on first attempt is higher than that of non-RSI (77.6% versus 61.9%; 95%CI for difference [9.3%-21.7%] p<0.0001) METHODS Study design Prospective observational multi-center data registry Study setting Data were obtained in the Japanese Emergency Airway Network (JEAN), consortium of 10 academic EDsin Japan. The participating sites are level Ⅰ(N=9) or level Ⅱ (N=1) trauma centers with an average annual ED census of 31,000 patient visits. Eligibility Data were collected prospectively from March 2010 to February 2011. All patients who underwent intubation in the EDs were included. Data Collection and Processing Case ascertainment is passive, relying on self-report. After each intubation, the intubator complete a standardized form. Outcome measures Success rate of intubation with RSI and Non-RSI Complication event rate Data analysis descriptive data as proportions with 95% Confidential intervals(95%CI). Chi-squared test, p<0.05 as significance Comparing RSI with Non-RSI within 3rd attempts (Excluding Cardiac Arrest) Success rate of RSI within 3 attempts is higher than that of non-RSI (98.4% versus 95.2%; 95%CI for difference [0.6%-5.4%] p=0.0129). Comparing complication We recorded 40 complications in RSI (13.2%) and 89 complications in non-RSI (15.9%), without significant difference by method (p=0.3). Complications include vomit, airway injury, dental injury, bronchial intubation, esophageal intubation, arrythmia, hypotension, cardiac arrest and death. RESULTS CONCLUSION Total intubation 1486 cases (compliance rate 99% ) surgical airway; 7 cases nasal intubation; 9 cases Oral intubation 1470 cases cardiac arrest; 608 cases Oral intubation (excluding cardiac arrest) 862 cases In this multi-center prospective study in Japan, we demonstrated high degree of variation in use of RSI for ED intubations. Additionally we found the success rate of RSI on first and within 3 attempts were both higher than that of non-RSI. This study has the limitation of reporting bias and confounding by indication.