Success and failure rates of rapid sequence intubation versus non–rapid sequence intubation by air medical providers in 2,853 patients

Abstract

Study objectives: Rapid sequence intubation (RSI) has established itself as the superior method of airway management in most academic and community emergency departments. However, there remains some debate about the use of paralytics in the out-of-hospital setting and increased risk of failed airways and poor patient outcomes. Most air medical programs have adopted RSI as the preferred method of intubation and have developed training programs for their crews in the use of those medications. We propose that air medical crews are more successful at intubations using RSI rather than non-RSI techniques. Methods: This was a retrospective review using Golden Hour Data System's medical information management system that collects patient transport and treatment data from 13 air medical companies across the United States. Procedural data from all patients who underwent emergency intubations from 1998 to 2004 were analyzed for recorded intubation technique, medications used, and success and failure rates. The data were analyzed using χ2 statistics. Results: More than 30,000 patients were transported during the 7-year study period. A total of 2,853 patients (9% of patient encounters) had oral emergency intubation recorded as the primary route. A total of 1,944 (68%) intubations were performed by the RSI technique, and 909 (32%) were non-RSI. The success and failure rates by patient type are listed in the Table (17 non-RSI patients did not have a medical or trauma indication listed). Conclusion: This is the largest out-of-hospital intubation data series reported. RSI had significantly higher intubation success overall compared with non-RSI. This significance was also demonstrated in the trauma and burn patient population. Medical patients showed higher RSI success versus non-RSI, although the difference was not significant. There were fewer medical patients in this data set, which may be a limitation. In this study, air medical crews have higher success rates using RSI techniques than those reported for many ground EMS systems and approach success rates reported by emergency physicians. Study objectives: Rapid sequence intubation (RSI) has established itself as the superior method of airway management in most academic and community emergency departments. However, there remains some debate about the use of paralytics in the out-of-hospital setting and increased risk of failed airways and poor patient outcomes. Most air medical programs have adopted RSI as the preferred method of intubation and have developed training programs for their crews in the use of those medications. We propose that air medical crews are more successful at intubations using RSI rather than non-RSI techniques. Methods: This was a retrospective review using Golden Hour Data System's medical information management system that collects patient transport and treatment data from 13 air medical companies across the United States. Procedural data from all patients who underwent emergency intubations from 1998 to 2004 were analyzed for recorded intubation technique, medications used, and success and failure rates. The data were analyzed using χ2 statistics. Results: More than 30,000 patients were transported during the 7-year study period. A total of 2,853 patients (9% of patient encounters) had oral emergency intubation recorded as the primary route. A total of 1,944 (68%) intubations were performed by the RSI technique, and 909 (32%) were non-RSI. The success and failure rates by patient type are listed in the Table (17 non-RSI patients did not have a medical or trauma indication listed). Conclusion: This is the largest out-of-hospital intubation data series reported. RSI had significantly higher intubation success overall compared with non-RSI. This significance was also demonstrated in the trauma and burn patient population. Medical patients showed higher RSI success versus non-RSI, although the difference was not significant. There were fewer medical patients in this data set, which may be a limitation. In this study, air medical crews have higher success rates using RSI techniques than those reported for many ground EMS systems and approach success rates reported by emergency physicians.