Should you Intubate with the Head of the Bed Elevated (HOB)?

  • Data from the Anesthesia literature suggests greater first-pass success during intubation and less intubation-related complications (e.g., hypoxemia); the question is whether the same would be true for intubations in the Emergency Medicine department.
  • EM residents from two different academic centers were first trained to intubate with the HOB elevated and then the study began enrolling patients. Here's the article.
  • 231 intubations were evaluated and it was found that there was significantly higher first-pass success when the HOB was elevated to 45 degrees. There was also less cardiac arrest post-intubation as compared to patients who were supine.
  • It was also shown that for every 5 degrees that a patient's head was elevated, there was an 11% increased odds of first-pass success.
  • Bottom-line: Consider raising the HOB during your next intubation, especially if you have difficulty on your first pass and the patient was supine.