Check-UP Checklist
Trial question
What is the role of a verbal performance of a written preprocedural checklist in critically ill adults undergoing endotracheal intubation?
Study design
Multi-center
Open label
RCT
Population
Characteristics of study participants
37.0% female
63.0% male
N = 262
262 patients (97 female, 165 male).
Inclusion criteria: critically ill adult patients undergoing endotracheal intubation.
Key exclusion criteria: awake intubation planned; urgent requirement of intubation; treating clinicians felt a requirement of a specific pre-intubation checklist or patient positioning.
Interventions
N=130 checklist (a written, verbally performed, pre-intubation checklist).
N=132 usual care (no pre-intubation checklist).
Primary outcome
Lowest arterial oxygen saturation
92%
93%
93.0 %
69.8 %
46.5 %
23.3 %
0.0 %
Checklist
Usual
care
No significant
difference ↔
No significant difference in lowest SaO2 (92% vs. 93%; ARD -1, 95% CI -3.03 to 1.03).
Secondary outcomes
No significant difference in lowest SBP (112 mmHg vs. 108 mmHg; AD 4 mmHg, 95% CI -10.86 to 18.86).
No significant difference in procedure duration (120 seconds vs. 118 seconds; AD 2 seconds, 95% CI -3.55 to 7.55).
Borderline significant increase in the number of laryngoscopy attempts (1 attempt vs. 1 attempt).
Safety outcomes
No significant differences in severe life-threatening procedural complications, hospital death, aspiration, and airway trauma.
Conclusion
In critically ill adult patients undergoing endotracheal intubation, checklist was not superior to usual care with respect to lowest SaO2.
Reference
David R Janz, Matthew W Semler, Aaron M Joffe et al. A Multicenter Randomized Trial of a Checklist for Endotracheal Intubation of Critically Ill Adults. Chest. 2018 Apr;153(4):816-824.
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