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

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.
• 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.