A standardised approach to pre-hospital RSI in the UK; utility, governance and content of current pre-induction checklists

Burgess, Mark R; Perkins, Zane

doi:10.1186/1757-7241-23-s2-a16

Cited by 1 publication

(1 citation statement)

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“…[1][2][3] RSI has the potential to exacerbate or cause physiologic derangement 4,5 as well as prolong time on scene. 6,7 Many pre-hospital services have standard operating procedures (SOPs) [8][9][10] which are likely to improve efficiency. 11,12 SOPs typically represent a fusion of evidence-based medicine with expert consensus.…”

Section: Introductionmentioning

confidence: 99%

The effect of ketamine and fentanyl on haemodynamics during intubation in pre‐hospital and retrieval medicine

Ferguson

Miller

Partyka

et al. 2022

Acta Anaesthesiol Scand

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Background Ketamine use for rapid sequence intubation (RSI) is frequent in pre‐hospital and retrieval medicine (PHARM) and is associated with potentially deleterious haemodynamic changes, which may be ameliorated by concurrent use of fentanyl. Objectives To describe the frequency with which fentanyl is used in conjunction with ketamine in a system where its use is discretionary, and to explore any observed changes in haemodynamics with its use. Methods A retrospective observational study of over 800 patients undergoing RSI with ketamine ± fentanyl in the PHARM setting between 2015 and 2019. The primary outcome was the proportion of patients in each group who had a systolic blood pressure (SBP) outside a pre‐specified target range, with adjustment for baseline abnormality, within 10 min of anaesthetic induction. Results Eight hundred and seventy‐six patients were anaesthetised with ketamine, of whom 804 were included in the analysis. 669 (83%, 95% CI 80%–86%) received ketamine alone, and 135 (17%, 95% CI 14%–20%) received both fentanyl and ketamine. Median fentanyl dose was 1.1 mcg/kg (IQR 0.75–1.5 mcg/kg). Systolic blood pressure (SBP) at induction was consistently associated with SBP after intubation in multivariable logistic regression, but fentanyl use was not associated with a change in odds of meeting the primary outcome (OR 1.08; 95% CI 0.72–1.60), becoming hypertensive (OR 1.35; 95% CI 0.88–2.07) or hypotensive (OR 0.76; 95% CI 0.47–1.21). Conclusions The addition of fentanyl to ketamine for RSI was not associated with an alteration of the odds of post‐induction haemodynamic stability, although the doses used were low. These findings justify further study into the optimal dosing of fentanyl during RSI in pre‐hospital and retrieval medicine.

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