article · African Journal of Emergency Medicine
Respiratory failure causes high mortality across sub-Saharan Africa, where resource constraints and limited emergency training often complicate critical interventions like endotracheal intubation. Multiple intubation attempts carry a high risk of adverse events. To address this, a six-month quality improvement study at the University Teaching Hospital in Kigali, Rwanda, evaluated whether pre-assembled intubation kits and a standardized checklist could improve first-pass success and decrease complications. The study analysed adult emergency department patients across three months before and three months after introducing the tools. Ultimately, the introduction of the kits and checklists did not result in a statistically significant reduction in intubation complications or an improvement in first-pass success. Although fewer post-intubation adverse events were noted following the intervention, the shift was not statistically meaningful, highlighting the necessity for larger trials to evaluate structured airway protocols in low-resource environments.
Endotracheal intubation is a vital emergency procedure, yet repeated attempts frequently cause severe clinical harm. In low-resource settings facing high mortality from respiratory failure, identifying effective procedural aids is critical. Demonstrating that simple checklists and kits may not immediately change clinical outcomes helps healthcare systems avoid unverified assumptions and guides future implementation research.
This work informs hospital administrators, clinical educators, and emergency care teams seeking applied procedural improvements for low-resource clinical settings. The intervention involved testing operational tools, specifically pre-assembled kits and checklists, directly in a hospital environment. However, because the study found no statistically significant improvement, these protocols require further validation and refinement through larger trials before being packaged as standard operational solutions.
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Introduction: Sub-Saharan African countries experience high mortality rates from respiratory failure, with limited emergency medicine training and resources contributing to poor outcomes. While endotracheal intubation (ETI) is a critical emergency procedure, multiple intubation attempts are associated with severe complications. Data on intubation outcomes in Sub-Saharan Africa is scarce, existing research suggests high complication and mortality rates, with mixed results regarding efficacy of pre intubation checklists. This study aims to evaluate the effectiveness of pre-assembled ETI kits and checklists in improving first-pass ETI success rates and reducing complications in the emergency department at University Teaching Hospital - Kigali, Rwanda (CHUK). Methods: This six-month pre-post quality improvement study at the CHUK emergency department includes consenting participants 16 years or older requiring ETI. Data on patient demographics, intubation success, and complications was collected using a standardized form three months before and after implementation of intubation kits and checklists. Results: intubation complications were unchanged following implementation (OR 0.65, 95% CI 0.44-2.18, p = 0.94). Post-intubation complications occurred had fewer occurrences after intervention however, this was not a statistically significant difference. Discussion: Implementation of pre-assembled ETI kits with a standardized checklist did not significantly improve first-pass success or overall complications. However, the trend toward fewer post-intubation adverse events indicates a possible benefit that may have been underpowered to detect. These results underscore the importance of a larger study to clarify the impact of structured airway management in low resource settings.
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DOI: 10.1016/j.afjem.2026.100994
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