Abstract 308: A Preoxygenation “Bundle” Decreases Desaturation Events and Improves Intubation Success in Air Medical Rapid Sequence Intubation
Introduction: Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and has been associated with increased morbidity and mortality. Preoxygenation with positive-pressure ventilation (PPV) may delay the onset of desaturation. However, PPV may not be used aggressively with emergency RSI due to concern for gastric insufflation precipitating regurgitation and aspiration events.
Objective: To evaluate an aggressive preoxygenation protocol with regard to desaturation events during air medical RSI.
Methods: The RSI protocol used in our air medical program airway training model was modified to employ several interventions designed to optimize preoxygenation prior to initial laryngoscopy. These included: two-person bag-valve-mask (BVM) ventilation, “two-thumbs-up” hand positioning on the mask, correct application of cricoid pressure, aggressive use of nasopharyngeal and oropharyngeal airways, small-volume assisted ventilation prior to administration of RSI medications, and large-volume ventilation following sedation/paralysis but prior to the initial laryngoscopy attempt. This algorithm identified a target SpO2 value of at least 93% based on a previous investigation. Desaturation events [decrease in SpO2 to <90% or a continued decrease by at least 2% if initial SpO2 value was <90%] were identified using physiologic data exported from hand held oximeter-capnometer devices. The incidence of desaturation events was established over a 2-year period prior to and the subsequent 2-year period following implementation of these algorithm changes.
Results: A total of 155 RSI procedures were evaluated over the study period. Desaturation events decreased from 58% in the two years prior to the algorithm changes to 28% in the first year and 14% in the second year following implementation (chi-square test for trend p<0.01). In addition, the intubation success rate increased from 94% to 97% following implementation of the protocol. There were no reports of major aspiration events during the study period.
Conclusions: An aggressive preoxygenation protocol dramatically reduced the incidence of desaturation events and increased intubation success during air medical RSI without increasing aspiration events.
- © 2012 by American Heart Association, Inc.