Rapid Sequence Induction on trauma patients performed by a rural and suburban air ambulance service: a 16-month audit of practice

Abstract Background Rapid Sequence Induction (RSI) is used for emergency tracheal intubation to minimise the risk of pulmonary aspiration of stomach contents. Ketamine and propofol are two commonly used induction agents for RSI in trauma patients. Yet, no consensus exists on the optimal induction agent for RSI in the trauma population. The aim of this study was to compare 30-day mortality in trauma patients after emergency intubation prehospitally or within 30 min after arrival in the trauma centre using either ketamine or propofol for RSI. Methods In this investigator-initiated, retrospective study we included adult trauma patients emergently intubated with ketamine or propofol registered in the local trauma registry at Rigshospitalet, a tertiary university hospital that hosts a level-1 trauma centre. The primary outcome was 30-day mortality. Secondary outcomes included hospital and Intensive Care Unit length of stay as well as duration of mechanical ventilation. We analysed outcomes using multivariable logistic regression models adjusting for age, sex, injury severity score, shock (systolic blood pressure < 90 mmHg) and Glasgow Coma Scale score before intubation and present results as odds ratios (ORs) with 95% confidence intervals. Results From January 1st, 2015 through December 31st, 2019 we identified a total of 548 eligible patients. A total of 228 and 320 patients received ketamine and propofol, respectively. The 30-day mortality for patients receiving ketamine and propofol was 20.2% and 22.8% (P = 0.46), respectively. Adjusted OR for 30-day mortality was 0.98 [0.58–1.66], P = 0.93. We found no significant association between type of induction agent and hospital length of stay, Intensive Care Unit length of stay or duration of mechanical ventilation. Conclusions In this study, trauma patients intubated with ketamine did not have a lower 30-day mortality as compared with propofol.

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The use of cricoid pressure during rapid sequence induction in trauma patients – UK and European practice compared

Trauma ◽

10.1177/1460408615615599 ◽

2015 ◽

Vol 18 (1) ◽

pp. 21-27 ◽

Cited By ~ 2

Author(s):

Matthew Gwinnutt ◽

Jennifer Gwinnutt ◽

David Robinson

Keyword(s):

Cricoid Pressure ◽

Rapid Sequence Induction ◽

Trauma Patients ◽

Rapid Sequence ◽

Sequence Induction

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Introduction of a Rapid Sequence Induction Checklist and its effect on Compliance to Guidelines and Complications

Acta Anaesthesiologica Scandinavica ◽

10.1111/aas.13947 ◽

2021 ◽

Author(s):

Jakob Zeuchner ◽

Jonas Graf ◽

Louise Elander ◽

Jessica Frisk ◽

Mats Fredrikson ◽

...

Keyword(s):

Rapid Sequence Induction ◽

Rapid Sequence ◽

Sequence Induction

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Rapid sequence induction: where did the consensus go?

Scandinavian Journal of Trauma Resuscitation and Emergency Medicine ◽

10.1186/s13049-021-00883-5 ◽

2021 ◽

Vol 29 (1) ◽

Author(s):

Pascale Avery ◽

Sarah Morton ◽

James Raitt ◽

Hans Morten Lossius ◽

David Lockey

Keyword(s):

Cricoid Pressure ◽

Rapid Sequence Induction ◽

Hospital Environment ◽

Training Technique ◽

Rapid Sequence ◽

Gastric Aspiration ◽

Sequence Induction ◽

The Uk ◽

Key Aspects ◽

Risk Of Aspiration

Abstract Background Rapid Sequence Induction (RSI) was introduced to minimise the risk of aspiration of gastric contents during emergency tracheal intubation. It consisted of induction with the use of thiopentone and suxamethonium with the application of cricoid pressure. This narrative review describes how traditional RSI has been modified in the UK and elsewhere, aiming to deliver safe and effective emergency anaesthesia outside the operating room environment. Most of the key aspects of traditional RSI – training, technique, drugs and equipment have been challenged and often significantly changed since the procedure was first described. Alterations have been made to improve the safety and quality of the intervention while retaining the principles of rapidly securing a definitive airway and avoiding gastric aspiration. RSI is no longer achieved by an anaesthetist alone and can be delivered safely in a variety of settings, including in the pre-hospital environment. Conclusion The conduct of RSI in current emergency practice is far removed from the original descriptions of the procedure. Despite this, the principles – rapid delivery of a definitive airway and avoiding aspiration, are still highly relevant and the indications for RSI remain relatively unchanged.

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COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen

Aktuelle Kardiologie ◽

10.1055/a-1314-9342 ◽

2020 ◽

Author(s):

Raphael Romano Bruno ◽

Georg Wolff ◽

Malte Kelm ◽

Christian Jung

Keyword(s):

Rapid Sequence Induction ◽

High Flow ◽

Ältere Personen ◽

Rapid Sequence ◽

Sind Eine ◽

Sequence Induction ◽

Thrombembolische Komplikationen ◽

Invasive Beatmung

ZusammenfassungEtwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.

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