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Related Experiment Videos

Prehospital rapid sequence induction by emergency physicians: is it safe?

C A Mackay1, J Terris, T J Coats

  • 1Helicopter Emergency Medical Service, Royal London Hospital, Whitechapel. cathymackay@hotmail.com

Emergency Medicine Journal : EMJ
|April 20, 2001
PubMed
Summary

Prehospital rapid sequence induction of anaesthesia (RSI) by emergency physicians showed no significant increase in intubation mishaps compared to anaesthetists. Emergency physicians safely administered necessary drugs in emergency situations.

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Area of Science:

  • Emergency Medicine
  • Anesthesiology

Background:

  • Rapid sequence induction of anaesthesia (RSI) is a critical procedure in prehospital emergency care.
  • Determining the safety and efficacy of RSI performed by different medical specialists is essential for patient outcomes.

Purpose of the Study:

  • To compare the practice and intubation mishap rates of anaesthetists and accident and emergency physicians performing RSI in the prehospital setting.

Main Methods:

  • Retrospective analysis of 359 patients undergoing RSI by Helicopter Emergency Medical Service (HEMS) doctors between 1997 and 1999.
  • Intubation mishaps were defined as repeat attempts, repeat drug administration, or failed intubation.

Main Results:

  • Emergency physicians performed RSI on 157 patients, anaesthetists on 202. Emergency physicians reported higher rates of difficult laryngoscopy (Cormack and Lehane grade 3 or 4) but were less likely to use a gum elastic bougie.

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  • No significant differences in post-intubation physiological parameters (pulse, blood pressure, oxygen saturation, end-tidal CO2) were observed between groups.
  • The failure rate for intubation was 1% in the anaesthetist group and 2.5% in the emergency physician group, with repeat attempts/drug administration <2% in both.

    • Conclusions:

    • RSI by emergency physicians in the prehospital setting was not associated with a significantly higher failure rate or increased intubation mishaps compared to anaesthetists.
    • Emergency physicians demonstrated the ability to safely administer sedative and neuromuscular blocking agents in prehospital RSI.
    • Findings suggest that emergency physicians can safely perform prehospital RSI and intubation.