Rapid sequence airway vs rapid sequence intubation in a simulated trauma airway by flight crew

Rapid sequence airway (RSA) utilizes rapid sequence intubation (RSI) pharmacology followed by the placement of an extraglottic airway without direct laryngoscopy.

To evaluate the difference in time to airway placement and lowest oxygen saturations in a simulated trauma patient using RSI or RSA with a Laryngeal Mask Airway-Supreme (LMAS).

This randomized, prospective, non-blinded, IRB-approved observational study used a SimMan human simulator in an ambulance. FC were randomly assigned to initially manage the patient with RSI or RSA. They then completed the same scenario with the other modality to serve as their own control. Trained assistants performed directed tasks. SimMan had an initial grade III view and desaturated along a standardized curve until intubation, LMAS, or bag-valve-mask ventilation (BVMV) was initiated. When BVMV was used, oxygen saturation increased along a standardized curve. The simulator's airway converted to a grade II view after the first attempt if difficult airway maneuvers were applied. Time, oxygen saturation, number of attempts and back-up airway placement were recorded.

Nineteen FC completed both paired modalities. Paired T-test was used for statistical analysis. Average time to secure the airway was 145 s shorter in the RSA group (95% CI: 100.4-189.7). Lowest oxygen saturation was 4.8% higher (95% CI: 2.8-6.8) in the RSA group. During RSI, FC placed a back-up airway 47% of the time.

In a simulated moderately difficult trauma airway managed by FC, RSA results in a significantly shorter time to secure the airway and less hypoxemia compared to RSI.