Written by Jason Lesnick
This secondary analysis found that intubation success correlated with experience, and competency likely is achieved between 35–50 intubations.
The ACGME was… right?
These authors determined if experience was associated with intubation success and, if so, how many intubations were needed to achieve competency.
This study was a secondary analysis of 2,839 intubations that occurred in EDs or ICUs from 8 different multicenter randomized controlled trials across 16 medical centers. Of those, 1,863 (65.6%) were by critical care medicine, 739 (26.0%) by emergency medicine, 154 (5.4%) by anesthesiology, and 83 (2.9%) by other clinicians (PA/NP/CRNA).
Greater prior intubation experience correlated with higher first-attempt success (OR 1.75, 95%CI 1.30–2.36; P<0.001) and improved lowest oxygen saturation (OR 1.45, 95%CI 1.21–1.73; P<0.001). Learning curves demonstrated outcome plateaus after approximately 35–50 intubations, suggesting this is the threshold of procedural competency for critically ill adult airway management. Learning curves were created by graphing the relationship between an operator’s prior number of intubations and the outcome after adjustment for covariables.
The greatest limitation in this study is that the top line finding relied on self-reported information from clinicians about their number of intubations performed.
How will this change my practice?
This paper is incredible! When I’m supervising someone I haven’t worked with before, I always ask how many intubations they have performed before they intubate, but now I have a much better idea of what to do with that information. Kudos to these authors for attempting to quantify procedural competency for critically ill patient intubation!
Source
Association Between Operator Experience and Procedural Outcomes of Tracheal Intubation in the Emergency Department and ICU. Ann Emerg Med. 2025 Aug 22:S0196-0644(25)01060-1. doi: 10.1016/j.annemergmed.2025.07.008. Epub ahead of print. PMID: 40848028.
