Yashvi Wimalasena1, Brian Burns2, Cliff Reid2, Sandra Ware3, Karel Habig3. 1. Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Emergency Department, Royal North Shore Hospital, Sydney, Sydney, NSW, Australia. Electronic address: yashvi299@yahoo.co.uk. 2. Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia. 3. Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia.
Abstract
STUDY OBJECTIVE: The Greater Sydney Area Helicopter Emergency Medical Service undertakes in excess of 2,500 physician/paramedic out-of-hospital and interhospital retrievals each year, of which 8% require intubation. Emergency anesthesia of critically ill patients is associated with complications, including hypoxia. In July 2011, the service introduced apneic oxygenation with nasal cannulae to its emergency anesthesia standard operating procedure to reduce rates of desaturation during rapid sequence intubation. We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation in both out-of-hospital and interhospital retrievals. METHODS: This was a retrospective study of prospectively collected airway registry data. Consecutive patients who underwent rapid sequence intubation by Greater Sydney Area Helicopter Emergency Medical Service personnel between September 2009 and July 2013, spanning the introduction of apneic oxygenation, were included for analysis (n=728). We compared patients who underwent rapid sequence intubation before the service introduced apneic oxygenation (n=310) with those who underwent it after its introduction (n=418). We evaluated the association between the introduction of apneic oxygenation and the incidence of desaturation. RESULTS: During the study period, 9,901 missions were conducted with 728 rapid sequence intubations (310 pre- and 418 postapneic oxygenation). The introduction of apneic oxygenation was followed by a decrease in desaturation rates from 22.6% to 16.5% (difference=6.1%; 95% confidence interval 0.2% to 11.2%). CONCLUSION: Introduction of apneic oxygenation was associated with decreased incidence of desaturation in patients undergoing rapid sequence intubation.
STUDY OBJECTIVE: The Greater Sydney Area Helicopter Emergency Medical Service undertakes in excess of 2,500 physician/paramedic out-of-hospital and interhospital retrievals each year, of which 8% require intubation. Emergency anesthesia of critically illpatients is associated with complications, including hypoxia. In July 2011, the service introduced apneic oxygenation with nasal cannulae to its emergency anesthesia standard operating procedure to reduce rates of desaturation during rapid sequence intubation. We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation in both out-of-hospital and interhospital retrievals. METHODS: This was a retrospective study of prospectively collected airway registry data. Consecutive patients who underwent rapid sequence intubation by Greater Sydney Area Helicopter Emergency Medical Service personnel between September 2009 and July 2013, spanning the introduction of apneic oxygenation, were included for analysis (n=728). We compared patients who underwent rapid sequence intubation before the service introduced apneic oxygenation (n=310) with those who underwent it after its introduction (n=418). We evaluated the association between the introduction of apneic oxygenation and the incidence of desaturation. RESULTS: During the study period, 9,901 missions were conducted with 728 rapid sequence intubations (310 pre- and 418 postapneic oxygenation). The introduction of apneic oxygenation was followed by a decrease in desaturation rates from 22.6% to 16.5% (difference=6.1%; 95% confidence interval 0.2% to 11.2%). CONCLUSION: Introduction of apneic oxygenation was associated with decreased incidence of desaturation in patients undergoing rapid sequence intubation.
Authors: Margaret M Parker; Gabrielle Nuthall; Calvin Brown; Katherine Biagas; Natalie Napolitano; Lee A Polikoff; Dennis Simon; Michael Miksa; Eleanor Gradidge; Jan Hau Lee; Ashwin S Krishna; David Tellez; Geoffrey L Bird; Kyle J Rehder; David A Turner; Michelle Adu-Darko; Sholeen T Nett; Ashley T Derbyshire; Keith Meyer; John Giuliano; Erin B Owen; Janice E Sullivan; Keiko Tarquinio; Pradip Kamat; Ronald C Sanders; Matthew Pinto; G Kris Bysani; Guillaume Emeriaud; Yuki Nagai; Melissa A McCarthy; Karen H Walson; Paula Vanderford; Anthony Lee; Jesse Bain; Peter Skippen; Ryan Breuer; Sarah Tallent; Vinay Nadkarni; Akira Nishisaki Journal: Pediatr Crit Care Med Date: 2017-04 Impact factor: 3.624
Authors: Matthew W Semler; David R Janz; Robert J Lentz; Daniel T Matthews; Brett C Norman; Tufik R Assad; Raj D Keriwala; Benjamin A Ferrell; Michael J Noto; Andrew C McKown; Emily G Kocurek; Melissa A Warren; Luis E Huerta; Todd W Rice Journal: Am J Respir Crit Care Med Date: 2016-02-01 Impact factor: 21.405
Authors: Geir Arne Sunde; Mårten Sandberg; Richard Lyon; Knut Fredriksen; Brian Burns; Karl Ove Hufthammer; Jo Røislien; Akos Soti; Helena Jäntti; David Lockey; Jon-Kenneth Heltne; Stephen J M Sollid Journal: BMC Emerg Med Date: 2017-07-11