Acute emergency care and airway management of caustic ingestion in adults: single center observational study

Background: Caustic ingestions are rare but potentially life-threatening events requiring multidisciplinary emergency approaches. Although particularly respiratory functions may be impaired after caustic ingestions, studies involving acute emergency care are scarce. The goal of this study was to explore acute emergency care with respect to airway management and emergency department (ED) infrastructures.

Methods: We retrospectively evaluated adult patients after caustic ingestions admitted to our university hospital over a 10-year period (2005-2014). Prognostic analysis included age, morbidity, ingested agent, airway management, interventions (endoscopy findings, computed tomography (CT), surgical procedures), intensive care unit (ICU) admission, length of stay in hospital and hospital mortality.

Results: Twenty-eight patients with caustic ingestions were included in the analysis of which 18 (64%) had suicidal intentions. Ingested agents were caustic alkalis (n = 22; 79%) and acids (n = 6; 21%). ICU admission was required in 20 patients (71%). Fourteen patients (50%) underwent tracheal intubation and mechanical ventilation, of which 3 (21%) presented with difficult airways. Seven patients (25%) underwent tracheotomy including one requiring awake tracheotomy due to progressive upper airway obstruction. Esophagogastroduodenoscopy (EGD) was performed in 21 patients (75%) and 11 (39%) underwent CT examination. Five patients (18%) required emergency surgery with a mortality of 60%. Overall hospital mortality was 18% whereas the need for tracheal intubation (P = 0.012), CT-diagnostic (P = 0.001), higher EGD score (P = 0.006), tracheotomy (P = 0.048), and surgical interventions (P = 0.005) were significantly associated with mortality.

Conclusions: Caustic ingestions in adult patients require an ED infrastructure providing 24/7-availability of expertise in establishing emergent airway safety, endoscopic examination (EGD and bronchoscopy), and CT diagnostic, intensive care and emergency esophageal surgery. We recommend that - even in patients with apparently stable clinical conditions - careful monitoring of respiratory functions should be considered as long as diagnostic work-up is completed.