Efficacy and Safety of Ventilator Assisted Preoxygenation for Intubation in Two Australian Emergency Departments: A Retrospective Cohort Study

ABSTRACT Objective This study describes the incidence of first‐pass intubation without hypoxaemia in patients who underwent endotracheal intubation using ventilator assisted preoxygenation (VAPOX). Methods Retrospective cohort study of adult patients who underwent VAPOX assisted endotracheal intubation between February 2021 and June 2025 in two EDs. The primary outcome was intubation with first‐pass success (FPS) without hypoxaemia (SpO 2 < 90%). Secondary outcomes included FPS, adverse events (hypoxia, hypotension, aspiration) and oxygenation trajectories (SpO 2 and FiO 2 ) pre‐ and post‐intubation. Results Of the 116 patients who received VAPOX, 78% (90/116; 95% CI 69%–84%) had FPS without hypoxaemia. Overall FPS occurred in 91% (105/116; 95% CI 84%–95%). Hypoxaemia (SpO 2 < 90%) occurred in 17% (20/116; 95% CI 11%–25%), including 11% (13/116; 95% CI 7%–18%) with severe hypoxaemia (SpO 2 < 85%) and 6% (7/116; 95% CI 3%–12%) with critical hypoxaemia (SpO 2 < 80%). Half of all patients experienced at least one complication (58/116; 50%, 95% CI 41%–59%). Post‐intubation hypotension (systolic blood pressure [SBP] < 90 mmHg) occurred in 36% of patients. No reported incidences of aspiration. Respiratory failure was the most common indication for intubation (60%) and was independently associated with a lower likelihood of success (OR 0.14; 95% CI 0.04–0.52). Conclusions We describe a cohort of patients who received VAPOX assisted ED intubation with a FPS without hypoxaemia of 78%. This was a critically ill cohort, with 46% of patients having oxygen saturations < 90% in the hour prior to intubation. These findings provide a benchmark for ED intubation using VAPOX and a comparison for future research.