Brief Research Report: Prehospital Rapid Sequence Airway

Area of Science:

• Emergency Medicine
• Critical Care
• Airway Management

Background:

• Rapid Sequence Airway (RSA) involves administering induction and paralytic agents followed by extraglottic airway device placement.
• This contrasts with traditional Rapid Sequence Intubation (RSI) which prioritizes endotracheal tube insertion.

Purpose of the Study:

• To evaluate the success rates of prehospital RSA.
• To determine the incidence of aspiration in patients managed with prehospital RSA.

Main Methods:

• A retrospective review of adult and pediatric prehospital RSA cases from 2005-2017 was conducted.
• Data was sourced from a quality assurance registry of ground and air medical agencies.
• Success was defined as adequate ventilation post-device placement; aspiration was identified via radiologic evidence within 48 hours.

Main Results:

• RSA was successful in 94% of 68 reviewed cases, with 88% achieved on the first attempt.
• The procedure was performed in various prehospital environments, including aircraft, with many patients in cervical precautions.
• Aspiration was identified in 8.7% of patients with available data.

Conclusions:

• Prehospital RSA exhibits high success rates and low aspiration rates, even in challenging patient populations.
• RSA presents a potentially effective alternative to RSI for prehospital airway management.
• Further research is warranted to fully establish RSA's role in emergency medicine.