Apnoeic oxygenation was associated with decreased desaturation rates during rapid sequence intubation in multiple Australian and New Zealand emergency departments

2020 ◽  
pp. emermed-2019-208424
Author(s):  
Adrian Perera ◽  
Hatem Alkouri ◽  
Toby Fogg ◽  
John Vassiliadis ◽  
John Mackenzie ◽  
...  
Keyword(s):  
New Zealand ◽  
Emergency Departments ◽  
Standard Care ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
Registry Study ◽  
Rapid Sequence ◽  
Registration Number ◽  
Apnoeic Oxygenation ◽  
Reduced Risk

Apnoeic oxygenation (ApOx) has been demonstrated to reduce the incidence of desaturation, although evidence of benefit has been conflicting depending on the technique used. The aim of this study was to compare the incidence of desaturation between patients who received ApOx via conventional nasal cannula (NC) and those who did not, using a large, multicentre airway registry.MethodsThis study is an analysis of 24 months of prospectively collected data in the Australia and New Zealand Emergency Department Airway Registry (June 2013–June 2015). The registry includes information on all intubated adults from 43 emergency departments. Patients intubated during cardiac arrest (n=393), those who received active ventilation prior to the first intubation attempt (n=486), and where the use of ApOx was not recorded either way (n=312) were excluded. The proportion of patients who desaturated (Sa02 <93) in the group that received ApOx and those that did not were compared. To evaluate the association of ApOx with patient desaturation, a logistic regression model based on factors expected to influence desaturation was performed.ResultsOf 2519 patients analysed, 1669 (66.3%) received ApOx via NC while 850 (33.7%) did not. Desaturation in the cohort receiving ApOx was 10.4% compared with standard care (no ApOx) 13.7%. ApOx had a protective effect for desaturation (OR 0.71 95% CI 0.53 to 0.95). Single intubation attempt was associated with reduced risk of desaturation of (OR 0.10, 95% CI 0.06 to 0.17); this was increased on second attempt (OR 0.37, 95% CI 0.21 to 0.68). Desaturation was also associated with the physician recording that they had anticipated a difficult airway (OR 1.83, 95% CI 1.34 to 2.48).ConclusionThis large multicentre registry study provides evidence that ApOx delivered through a conventional NC is associated with a lower incidence of desaturation in patients undergoing rapid sequence intubation.Trial registration numberACTRN12613001052729.

Airway Management In The Emergency Department

2018 ◽  
Author(s):  
Garrett S. Pacheco ◽  
Bryan Wilson
Keyword(s):  
Airway Management ◽  
Difficult Airway ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
Emergency Airway Management ◽  
Emergency Airway ◽  
Airway Emergency ◽  
Rapid Sequence ◽  
First Pass ◽  
Surgical Airway

Emergency airway management has evolved tremendously since the onset of the specialty’s origin. Over the years, the importance of first-pass success and approach to the difficult airway were the primary challenges faced by emergency physicians. With the advent of video laryngoscopy, the rates of first-pass success continue to increase, and the effect of the anatomically difficult airway has begun to lessen. With advances in tools for airway management, the challenges have shifted to approaching optimal preoxygenation and correction of physiologic disturbances prior to any intubation attempt. This review discusses traditional rapid sequence intubation and advances in the field of emergency airway management.  This review contains 6 figures, 6 tables and 74 references Key words: difficult airway, emergency airway management, preoxygenation, surgical airway

scholarly journals Laryngoscopic views during rapid sequence intubation in the emergency department

CJEM ◽  
2004 ◽  
Vol 6 (06) ◽  
pp. 416-420 ◽  
Author(s):  
Colin A. Graham ◽  
Angela J. Oglesby ◽  
Diana Beard ◽  
Dermot W. McKeown
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Descriptive Analysis ◽  
Rapid Sequence Intubation ◽  
Intubation Attempt ◽  
Emergency Physicians ◽  
Rapid Sequence ◽  
Lehane Grade ◽  
Visualization Techniques

ABSTRACT:Objectives:Our objective was to document and compare the views obtained at laryngoscopy during emergency department (ED) rapid sequence intubation (RSI) by anesthetists and emergency physicians of varying seniority and experience.Methods:Data were prospectively collected on every intubation attempt in 7 urban Scottish EDs for 2 calendar years, commencing Jan. 11, 1999. Data included patient’s age, gender, grade and specialty of intubator, laryngoscopic grade, and number of intubation attempts. Quality of laryngoscopic visualization was graded using the Cormack–Lehane scale, with grades I and II considered good visualization. A descriptive analysis was performed, and key statistical comparisons made.Results:During the study period, 735 patients underwent RSI, and grade of intubation was documented in 672 cases (91%). In total, 68.2%, 23.4%, 6.1% and 2.4% of the intubations were classified as Cormack–Lehane grade I, II, III and IV respectively. Overall, anesthetists and anesthesia trainees achieved good laryngoscopic visualization in 94.0% of cases (95% confidence interval [CI], 90.8%–96.4%) and emergency physicians and emergency medicine trainees did so in 89.2% of cases (95% CI, 85.5%–92.3%;p= 0.027). Specialist registrars and senior house officers in anesthesia were more likely to obtain good visualization than their emergency medicine counterparts (p= 0.034 and 0.035 respectively). Consultants in emergency medicine were more likely to obtain good views than their anesthesia counterparts, but this difference was not statistically significant.Conclusions:Anesthetic trainees obtain better laryngoscopic views than emergency medicine trainees, but these differences disappear with increasing emergency physician seniority, suggesting a training and experience effect. Emergency medicine trainees may benefit from additional focus on laryngoscopic visualization techniques early in their training period.

scholarly journals The HEAVEN criteria predict laryngoscopic view and intubation success for both direct and video laryngoscopy: a cohort analysis

2019 ◽  
Vol 27 (1) ◽  
Author(s):  
Fauzia Nausheen ◽  
Nichole P. Niknafs ◽  
Derek J. MacLean ◽  
David J. Olvera ◽  
Allen C. Wolfe ◽  
...  
Keyword(s):  
Cohort Analysis ◽  
Oxygen Desaturation ◽  
Video Laryngoscopy ◽  
Rapid Sequence Intubation ◽  
Physiological Data ◽  
Intubation Attempt ◽  
Laryngoscopic View ◽  
Rapid Sequence ◽  
Intubation Success ◽  
Neck Mobility

Abstract Background Existing difficult airway prediction tools are not practical for emergency intubation and do not incorporate physiological data. The HEAVEN criteria (Hypoxaemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguination, Neck mobility) may be more relevant for emergency rapid sequence intubation (RSI). Methods A retrospective analysis included air medical RSI patients. A checklist was used to assess HEAVEN criteria prior to RSI, and Cormack-Lehane (CL) laryngoscopic view was recorded for the first intubation attempt. The incidence of a difficult (CL III/IV) laryngoscopic view as well as failure to intubate on first attempt with and without oxygen desaturation were determined for each of the HEAVEN criteria and total number of HEAVEN criteria. In addition, the association between HEAVEN criteria and both laryngoscopic view and intubation performance were quantified using multivariate logistic regression for direct laryngoscopy (DL) and video laryngoscopy (VL) configured with a Macintosh #4 non-hyperangulated blade. Results A total of 5137 RSI patients over 24 months were included. Overall intubation success was 97%. A CL III/IV laryngoscopic view was reported in 25% of DL attempts and 15% of VL attempts. Each of the HEAVEN criteria and total number of HEAVEN criteria were associated with both CL III/IV laryngoscopic view and failure to intubate on the first attempt with and without oxygen desaturation for both DL and VL. These associations persisted after adjustment for multiple co-variables including the other HEAVEN criteria. Conclusion The HEAVEN criteria may be useful to predict laryngoscopic view and intubation performance for DL and VL during emergency RSI.

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