T Warnecke1, M Dobbermann2, T Becker3, M Bernhard4,5, J Hinkelbein6. 1. Klinik für Anästhesiologie, Intensiv- und Notfallmedizin, Evangelisches Klinikum Niederrhein, Fahrner Straße 133, 47169, Duisburg, Deutschland. tobias.warnecke@evkln.de. 2. Klinik für Anästhesie, Operative Intensiv- und Palliativmedizin, Städtisches Klinikum Solingen gGmbH, Akademisches Lehrkrankenhaus der Universität zu Köln, Solingen, Deutschland. 3. Department of Emergency Medicine, University of Florida, Gainesville, FL, USA. 4. Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland. 5. Arbeitsgruppe "Trauma- und Schockraummanagement" des Arbeitskreises Notfallmedizin der Deutschen Gesellschaft für Anästhesiologie und Intensivmedizin, Nürnberg, Deutschland. 6. Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Köln (AöR), Köln, Deutschland.
Abstract
BACKGROUND: The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP). MATERIAL AND METHODS: Between 1 April 2017 and 31 May 2017, EMS medical directors in Germany were contacted and asked to distribute a 28-question online questionnaire to local EMS physicians. Of the questions 26 were multiple choice and 2 with plain text. After 6 weeks an e‑mail reminder was sent. In addition, the survey was distributed via social media to EMS physicians. RESULTS: In total the survey was opened 2314 times and 1074 completed responses were received (completion rate 46%). Most of the participants were male (78%) and anesthesiologists (70%) and only one quarter had a local SOP for RSI. The most frequently used muscle relaxant was succinylcholine (62%) and over half of the participants reported using cricoid pressure (57%). There was a distinction between the specialist disciplines in the selection of drugs. Propofol was used most by anesthesiologists, while the others still used etomidate on a larger scale. Nearly 100% could fall back on supraglottic devices (one third laryngeal mask, two thirds laryngeal tube) but only 32.8% with the recommended esophageal drainage. A video laryngoscope was available to 51% of all EMS physicians surveyed. CONCLUSION: The results of the survey demonstrate heterogeneity in RSI techniques used by EMS physicians in Germany. Medical equipment and safe care practices, such as labeling of syringes varied considerably between different service areas. The recommendations of the S1 national guidelines on emergency airway management and anesthesia should be adhered to together with the implementation of local SOPs.
BACKGROUND: The goal of rapid sequence induction (RSI) in cases of emergency situations is to secure the airway as quickly as possible to prevent pulmonary aspiration of gastric contents; however, the technique itself is not standardized. For example, the choice of drugs, application of cricoid pressure and the patient position remain controversial. A survey of emergency medical services (EMS) physicians throughout Germany was carried out to assess the different RSI techniques used and with respect to complying with the national guidelines for emergency airway management anesthesia and local standard operating procedures (SOP). MATERIAL AND METHODS: Between 1 April 2017 and 31 May 2017, EMS medical directors in Germany were contacted and asked to distribute a 28-question online questionnaire to local EMS physicians. Of the questions 26 were multiple choice and 2 with plain text. After 6 weeks an e‑mail reminder was sent. In addition, the survey was distributed via social media to EMS physicians. RESULTS: In total the survey was opened 2314 times and 1074 completed responses were received (completion rate 46%). Most of the participants were male (78%) and anesthesiologists (70%) and only one quarter had a local SOP for RSI. The most frequently used muscle relaxant was succinylcholine (62%) and over half of the participants reported using cricoid pressure (57%). There was a distinction between the specialist disciplines in the selection of drugs. Propofol was used most by anesthesiologists, while the others still used etomidate on a larger scale. Nearly 100% could fall back on supraglottic devices (one third laryngeal mask, two thirds laryngeal tube) but only 32.8% with the recommended esophageal drainage. A video laryngoscope was available to 51% of all EMS physicians surveyed. CONCLUSION: The results of the survey demonstrate heterogeneity in RSI techniques used by EMS physicians in Germany. Medical equipment and safe care practices, such as labeling of syringes varied considerably between different service areas. The recommendations of the S1 national guidelines on emergency airway management and anesthesia should be adhered to together with the implementation of local SOPs.
Authors: M Bernhard; T Hilger; M Sikinger; C Hainer; S Haag; K Streitberger; E Martin; A Gries Journal: Anaesthesist Date: 2006-11 Impact factor: 1.041
Authors: Ralph J Frascone; Christopher Russi; Charles Lick; Marc Conterato; Sandi S Wewerka; Kent R Griffith; Lucas Myers; Jennifer Conners; Joshua G Salzman Journal: Resuscitation Date: 2011-07-18 Impact factor: 5.262
Authors: Christian Sitzwohl; Angelika Langheinrich; Andreas Schober; Peter Krafft; Daniel I Sessler; Harald Herkner; Christopher Gonano; Christian Weinstabl; Stephan C Kettner Journal: BMJ Date: 2010-11-09