Pre-hospital rapid sequence induction by paramedics: A scoping review

Abstract

Background: There is conflict in the literature addressing the role of paramedics in the outcomes and potential complications of rapid sequence induction (RSI) in pre-hospital settings. Objective: This review aims to describe the common indications, complications, anesthetic agents, and success rate of RSI, as performed by paramedics at a pre-hospital setting. Method: This scoping review utilized the PRISMA® flow diagram to guide the literature searching process across multiple resources. MEDLINE, Google Scholar, and PubMed search engines were accessed and searched for related articles using different combinations of keywords. The quality of the selected articles was assessed via the critical appraisal skills program. Results: Twenty-seven articles were included in this review. The main indication of RSI was the loss of consciousness due to different physical disorders. Potential complications include hypoxia, hypotension, and hypo-/hypercapnia. Anesthetic agents ketamine and succinylcholine were extensively used. Success rates of RSI, if performed by paramedics, ranged from 45% to 92%. Conclusion: Endotracheal intubation (ETI) with RSI has various indications and sedative agents that, if used appropriately, increase the victim’s survival rates. Also, ETI with RSI is associated with several complications and challenges that affect the success rate, especially for the first intubation attempt.