First-pass success matters.
Every additional intubation attempt increases the risk of hypoxemia, aspiration, airway trauma, esophageal intubation, hypotension, and cardiac arrest.
In the operating room, airway management often occurs under controlled conditions.
In emergency and critical care, it rarely does.
Critically ill patients may be hypoxemic, acidemic, hypotensive, combative, vomiting, bleeding, or unable to tolerate prolonged apnea.
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