The process of rapid sequence intubation in the prehospital setting: A scoping review

Ensuring that the patient's airway is secured is one of the essential priorities for emergency care providers in the prehospital setting. Rapid sequence intubation (RSI) intervention allows the administration of induction and paralytic medications that optimise the conditions for insertion of the endotracheal tube. RSI is essential in the management of critically ill patients to address the risks of aspiration of gastric contents and morbidity and premature mortality.

To systematically explore, map, describe, and provide the extent and nature of published research of the most up-to-date evidence-based elements and guidance of RSI in the prehospital setting.

This scoping review followed a framework proposed by Arksey and O'Malley and refined by the Joanna Briggs Institute. The following databases were utilised to guide the literature searching process across multiple resources: Scopus, Web of Science and PubMed engines. The articles included were full-text publications written in English, published between 2000 and 2023. A search strategy incorporating different combinations of keywords was developed with the assistance of a librarian. A population, context and concepts (PCC) framework was used to guide the inclusion criteria of identified articles. The selected titles and full-text articles were screened on Rayyan software (Rayyan, USA) and presented on the PRISMA flow diagram. Data were extracted and displayed on an Excel spreadsheet (Microsoft Corp, USA). Concepts were identified, categorised, and grouped into themes through thematic analysis.

A total of 2 585 titles and abstracts were screened after duplicates had been removed. Only 138 full-text articles were screened, and 40 articles met eligibility criteria. Categories that were formed from concepts identified were grouped into seven themes, which included: RSI preparations, RSI procedure, training, system requirements, clinical governance, standardisation of RSI, and potential adverse events (AEs) associated with prehospital RSI (PRSI).

The seven themes generated from this review indicate that safe, effective, and successful PRSI is achievable, with success and complication rates comparable to, or better than, those in in-hospital settings. The findings underscore that PRSI is a complex intervention that must be performed by appropriately trained personnel. Furthermore, the review highlights the importance of using a well-practised checklist approach and implementing a robust clinical governance framework to minimise AEs, support continuous quality improvement, enhance patient safety, and ultimately improve clinical outcomes.

This scoping review contributes to the existing body of knowledge by synthesising the current best evidence on rapid sequence intubation in the prehospital setting. The study highlights key trends, best practices and gaps, providing valuable insights to guide clinical practice, inform training protocol, and support future research aimed at improving patient outcomes during prehospital airway management.