Abstract
BackgroundAlthough airway management with neuromuscular blockade (NMB) alone is discouraged in the emergency department (ED), our previous study demonstrated that many patients were intubated using NMBs alone without sedatives. To refute this practice, we sought to compare the intubation success and adverse event rates between NMBs only and rapid sequence intubation (RSI).MethodsThis is a secondary analysis of the data from a prospective observational study of ED patients in 13 hospitals who underwent emergency airway management from April 2010 to August 2012. The primary outcome was intubation success rate on first attempt. The secondary outcomes were the intubation success rate in ≤2 attempts and the intubation-related adverse event rate. We compared these outcomes between intubation attempts using NMB alone and RSI. We fit multivariable logistic regression models adjusting for potential confounders (age, sex, weight, primary indication for intubation, and training level of intubators).ResultsOverall, 852 patients were eligible for this analysis, with 114 (13%) intubated with NMB alone and 738 (87%) with RSI. Between the NMB-alone and RSI groups, no significant differences were observed in the success rate on the first attempt (70 vs. 73%; P = 0.48) or in ≤2 attempts (89 vs. 91%; P = 0.46), or in the adverse event rate (11 vs. 12%; P = 0.58). Similarly, after adjusting for confounders, no significant differences were observed in any of these outcomes (all P > 0.05).ConclusionsIn this analysis of data from a large multicenter study of ED patients, we found no superior effectiveness of intubation with NMB alone when compared to RSI. Our data lend significant support to the concept that intubation with NMB alone should be avoided in the ED.
Highlights
Airway management with neuromuscular blockade (NMB) alone is discouraged in the emergency department (ED), our previous study demonstrated that many patients were intubated using NMBs alone without sedatives
Between the NMB-alone and rapid sequence intubation (RSI) groups, no significant differences were observed in the success rate on the first attempt (70 vs. 73%; unadjusted odds ratio [OR], 0.9; 95% confidence interval [CI] 0.6–1.3; P = 0.48; Table 2) or in ≤2 attempts (89 vs. 91%; unadjusted OR, 0.8; 95% CI 0.4–1.5; P = 0.46), or in the adverse event rate (11 vs. 12%; unadjusted OR, 0.8; 95% CI 0.4–1.6; P = 0.58)
NMB neuromuscular blockade, RSI rapid sequence intubation, OR odds ratio, CI confidence interval a Patients may have more than 1 adverse event
Summary
Airway management with neuromuscular blockade (NMB) alone is discouraged in the emergency department (ED), our previous study demonstrated that many patients were intubated using NMBs alone without sedatives To refute this practice, we sought to compare the intubation success and adverse event rates between NMBs only and rapid sequence intubation (RSI). To our knowledge, no studies have examined the effectiveness of emergency airway management with NMB alone to refute this approach. In this context, by using the data from a multicenter prospective study of ED airway management, we aimed to compare the intubation success and adverse event rates between the patients intubated with NMB alone and those intubated with RSI
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