Original ResearchPreoxygenation Reduces Desaturation Events and Improves Intubation Success
Section snippets
Design
This was a prospective, before and after study conducted from 2005 to 2008. A wavier of informed consent was granted by our investigational review board.
Setting
Mercy Air Medical Services includes 8 bases throughout Southern California. Flight crews routinely perform RSI for specific indications, including coma from any cause as well as severe respiratory distress. The protocol during the study period included routine administration of etomidate and succinylcholine before intubation attempts, with
Results
A total of 155 RSI procedures were included in this analysis (81 preintervention and 74 postintervention). Desaturation events decreased from 58% (2005-2006) in the years before the algorithm changes to 28% (2007) in the first year and 14% (2008) in the second year after implementation (P < .01) (Fig. 1). Overall intubation success rates increased from 89% in the years before introduction of the algorithm changes to 94% the year after its introduction and 98% the second year after
Discussion
Although advanced airway management represents a cornerstone of out-of-hospital resuscitative care, the high potential for desaturations and possibility of failure underscore the importance of an optimal approach emphasizing preoxygenation and aggressive training. In a prior study, we documented a high rate of desaturations during RSI with SpO2 values below 93% with initial laryngoscopy.5 In response, we modified our advanced airway management protocols to emphasize preoxygenation strategies,
Conclusions
In this brief report, the implementation of a preoxygenation bundle using PPV via BVM to achieve SpO2 ≥ 93% before RSI was associated with a significant decrease in desaturation events as well as improved ETI success rates, without a concomitant increase in aspiration events. Although further research is needed to fully evaluate the downstream effects of adoption this protocol, the results of this study in combination with the lack of evidence supporting a clear association between PPV during
References (14)
- et al.
Incidence of transient hypoxia and pulse rate reactivity during paramedic rapid sequence intubation
Ann Emerg Med
(2003) - et al.
Latency of pulse oximetry signal with use of digital probes associated with inappropriate extubation during prehospital rapid sequence intubation in head injury patients: case examples
J Emerg Med
(2012) - et al.
The respiratory system during resuscitation: a review of the history, risk of infection during assisted ventilation, respiratory mechanics, and ventilation strategies for patients with an unprotected airway
Resuscitation
(2001) - et al.
Prehospital use of succinylcholine: a 20-year review
Prehosp Emerg Care
(1999) - et al.
Hypotension, hypoxia, and head injury: frequency, duration, and consequences
Arch Surg
(2001) Preoxygenation: best method for both efficacy and efficiency
Anesthesiology
(1999)- et al.
Rate of decline in oxygen saturation at various pulse oximetry values with prehospital rapid sequence intubation
Prehosp Emerg Care
(2008)