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Patient outcomes following prehospital rapid sequence intubation for medical emergencies
Critical Care volume 8, Article number: P286 (2004)
Prehospital rapid sequence intubation (RSI) is an intervention utilized for airway management in noncardiac arrested patients. We report patient outcomes following prehospital RSI utilized for medical emergencies.
Airway management with prehospital RSI for medical emergencies improves patient outcomes.
A retrospective, observational evaluation of a RSI database reflecting a 40-month experience with prehospital RSI performed for medical emergencies. Data was compiled from advanced life-support ambulance services from five distinct, suburban–rural cities all utilizing identical RSI protocols with training conducted by a single individual. RSI was indicated for Glasgow Coma Scores < 8, rapidly declining respiratory and/or hemodynamic status, or persistent hypoxia or unresponsiveness in the presence of assisted ventilation and oxygen therapy. Etomidate and succinylcholine were the agents utilized for sedation and paralysis, respectively. Laryngoscopy was limited to 30 s with no more than three intubation attempts permitted. Medical records from the initial receiving hospital were reviewed for patients meeting prehospital RSI criteria.
Eighty-seven patients underwent prehospital RSI for medical emergencies. Outcome data is available for 71/87 (82%). Neurologic (30 patients), respiratory (21 patients) and drug overdoses (15 patients) comprised the most common indications for RSI. Twenty-seven out of 71 (38%) died as a result of their underlying medical conditions, which included 14/30 neurologic, 10/21 respiratory and 0/15 drug overdose patients. Six patients, all with respiratory distress, experienced cardiac arrests immediately following RSI, none of whom were resuscitated. Patients surviving their neurologic event required prolonged rehabilitation. No patient demonstrated evidence for aspiration pneumonia related to RSI. In the same time period, outcome data is available for 58 patients meeting RSI criteria but not receiving the intervention. Fifteen out of 58 (28%) died as a result of their underlying conditions and not airway management interventions.
RSI does not appear to significantly improve patient outcomes when utilized for medical emergencies. Respiratory emergency patients are at high risk for RSI-related cardiac arrest. Justifying this intervention in our nonurban practice is difficult.
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McGlinch, B., Weller, E. Patient outcomes following prehospital rapid sequence intubation for medical emergencies. Crit Care 8 (Suppl 1), P286 (2004). https://doi.org/10.1186/cc2753