Abstract
Background: Emergency rapid sequence intubation (RSI) performed outside the operating room on emergency patients is the cornerstone of emergency airway management. Complication rates are unknown for this procedure in the United Kingdom and the factors contributing to immediate complications have not been identified.
Aims: To quantify the immediate complications of RSI and to assess the contribution made by environmental, patient, and physician factors to overall complication rates.
Methods: Prospective observational study of 208 consecutive adult and paediatric patients undergoing RSI over a six month period.
Results: Patients were successfully intubated by RSI in all cases. There were no deaths during the procedure and no patient required a surgical airway. Patient diagnostic groups requiring RSI are described. Immediate complications were hypoxaemia 19.2%, hypotension 17.8%, and arrhythmia 3.4%. Hypoxaemia was more common in patients with pre-existing respiratory or cardiovascular conditions than in patients with other diagnoses (p<0.01). Emergency department intubations were associated with a significantly lower complication rate than other locations (16.9%; p = 0.004). This can be explained by the difference in diagnostic case mix. Intubating teams comprised anaesthetists, non-anaesthetists, or both. There were no significant differences in complication rates between these groups.
Conclusions: RSI has a significant immediate complication rate, although the clinical significance of transient events is unknown. The likelihood of immediate complications depends on the patient's underlying condition, and relevant diagnoses should be emphasised in airway management training. Complication rates are comparable between anaesthetists and non-anaesthetists. The significantly lower complication rates in emergency department RSI can be explained by a larger proportion of patients with comparatively stable cardiorespiratory function.
Full Text
The Full Text of this article is available as a PDF (135.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Butler J. M., Clancy M., Robinson N., Driscoll P. An observational survey of emergency department rapid sequence intubation. Emerg Med J. 2001 Sep;18(5):343–348. doi: 10.1136/emj.18.5.343. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Crosby E. T., Cooper R. M., Douglas M. J., Doyle D. J., Hung O. R., Labrecque P., Muir H., Murphy M. F., Preston R. P., Rose D. K. The unanticipated difficult airway with recommendations for management. Can J Anaesth. 1998 Aug;45(8):757–776. doi: 10.1007/BF03012147. [DOI] [PubMed] [Google Scholar]
- Gwinnutt C. L. The interface between anaesthesia and emergency medicine. Emerg Med J. 2001 Sep;18(5):325–326. doi: 10.1136/emj.18.5.325. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Lockey D. J., Black J. J. M. Emergency physicians: additional providers of emergency anaesthesia? Anaesthesia. 2002 Jul;57(7):629–631. doi: 10.1046/j.1365-2044.2002.02747.x. [DOI] [PubMed] [Google Scholar]
- Petrack E. M., Hollinger I. Teaching rapid sequence intubation to pediatric emergency physicians: a pilot course. Resuscitation. 1994 Dec;28(3):215–219. doi: 10.1016/0300-9572(94)90066-3. [DOI] [PubMed] [Google Scholar]
- SELLICK B. A. Cricoid pressure to control regurgitation of stomach contents during induction of anaesthesia. Lancet. 1961 Aug 19;2(7199):404–406. doi: 10.1016/s0140-6736(61)92485-0. [DOI] [PubMed] [Google Scholar]
- Sakles J. C., Laurin E. G., Rantapaa A. A., Panacek E. A. Airway management in the emergency department: a one-year study of 610 tracheal intubations. Ann Emerg Med. 1998 Mar;31(3):325–332. doi: 10.1016/s0196-0644(98)70342-7. [DOI] [PubMed] [Google Scholar]
- Tayal V. S., Riggs R. W., Marx J. A., Tomaszewski C. A., Schneider R. E. Rapid-sequence intubation at an emergency medicine residency: success rate and adverse events during a two-year period. Acad Emerg Med. 1999 Jan;6(1):31–37. doi: 10.1111/j.1553-2712.1999.tb00091.x. [DOI] [PubMed] [Google Scholar]