Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents

Ma, O.John; Atchley, R.Brett; Hatley, Todd; Green, Mike; Young, Jeffrey S.; Brady, William J.

doi:10.1016/s0735-6757(98)90027-4

Cited by 81 publications

(36 citation statements)

References 11 publications

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“…The likelihood of successful endotracheal tube placement with minimal complications is related to the length of training, supervised experience in the operating room and in the field, 64,65 adequate ongoing experience, 66 and use of rapid sequence intubation (RSI). 67,68 Rapid Sequence Intubation (RSI)…”

Section: Ventilation With An Endotracheal Tubementioning

confidence: 99%

Part 14: Pediatric Advanced Life Support

Kleinman¹,

Chameides²,

Schexnayder³

et al. 2010

Circulation

915

304

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Section: Ventilation With An Endotracheal Tubementioning

confidence: 99%

Part 14: Pediatric Advanced Life Support

Kleinman¹,

Chameides²,

Schexnayder³

et al. 2010

Circulation

915

304

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“…Finally, there are three retrospective studies that assess the impact of the introduction of an RSI protocol on intubation success in aeromedical transport. [19][20][21] All three reports documented an increase in the rate of intubation success with fewer intubation attempts and more rapid achievement of intubation with RSI compared with non-NMBA techniques.…”

Section: Answering the Primary Question -The Impact Of Rsi In Aspiratmentioning

confidence: 99%

No evidence for decreased incidence of aspiration after rapid sequence induction

Neilipovitz

Crosby

2007

Can J Anesth/J Can Anesth

150

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Purpose:The purpose of this structured, evidence-based, clinical update was to determine if rapid sequence induction is a safe or effective technique to decrease the risk of aspiration or other complications of airway management. Source:In June 2006 a structured search of MEDLINE from 1966 to present using OVID software was undertaken with the assistance of a reference librarian. Medical subject headings and text words describing rapid sequence induction or intubation (RSI), crash induction or intubation, cricoid pressure and emergency airway intubation were employed. OVID's therapy (sensitivity) algorithm was used to maximize the detection of randomized trials while excluding non-randomized research. The bibliographies of eligible publications were hand-searched to identify trials not identified in the electronic search. Principal findings:A total of 184 clinical trials were identified of which 163 were randomized controlled trials (RCTs). Of these clinical trials, 126 evaluated different drug regimens with 114 being RCTs. Only 21 clinical trials evaluated non-pharmacologic aspects of the RSI with 18 RCTs identified. A parallel search found 52 trials evaluating cricoid pressure (outside of the context of an RSI technique) with 44 classified as RCTs. Definitive outcomes such as prevention of aspiration and mortality benefit could not be evaluated from the trials. Likewise, the impact on adverse outcomes of the different components of RSI could not be ascertained. Conclusion:An absence of evidence from RCTs suggests that the decision to use RSI during management can neither be supported nor discouraged on the basis of quality evidence.

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“…(Figure 3 Even in patients with a Glasgow Coma Scale score of 3, there is airway reactivity (gag and cough reflexes) with a considerable potential to promote intubation failure. 27 RSI with a sedative induction agent (e.g., thiopental, ketamine, or etomidate) followed by administration of a rapidly acting neuromuscular blocking agent (e.g., succinylcholine) to induce unconsciousness and motor paralysis is associated with a decrease in intubation failures and complications 28,29 and is the gold standard for emergency intubation attempts. 30 RSI requires familiarity with patient evaluation, airwaymanagement techniques, sedation agents, neuromuscular blocking agents, additional adjunctive agents, and postintubation management techniques.…”

Section: Rapid Sequence Intubation (Rsi)mentioning

confidence: 99%

Airway Management in Trauma

2015

IJAA

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The treatment of the seriously injured patient requires rapid assessment of the injuries and institution of lifepreserving therapy. Inadequate delivery of oxygenated blood to the brain and other vital structures is the quickest killer of the injured. Ensuring an unobstructed airway and adequate oxygenation are first priorities in the resuscitation of the trauma patient. Unlike the elective surgical patient the trauma patients present many challenges (Figure 1).A diverse array of equipment and skills are necessary for optimal airway management. AbstractAirway Management for the victims of major trauma is the first priority in the care of the trauma victim and is a core skill in emergency medicine and critical care. Endotracheal intubation remains the gold standard for trauma airway management. Airway management in trauma patients is not just the capability to insert an oral/nasal airway or endotracheal tube beyond the vocal cords. The five components integral to modern, sophisticated airway management in trauma patients include equipment, pharmacologic adjuncts, manual techniques, physical circumstances, and patient profile. A trauma patient may require airway management in a variety of physical circumstances. Whereas, the commonly used airway management algorithms may not suffice in all these situations, the construction of a truly complete decision tree is also virtually impossible. There is consensus that it is not the intervention per se but rather the conditions, skills, and performance that might be the possible variables that affect outcome. Paramedics have only limited experience and on-the-job skills for invasive airway management. Difficult airway management is best left for the experienced physicians to handle.

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Intubation success rates improve for an air medical program after implementing the use of neuromuscular blocking agents

Cited by 81 publications

References 11 publications

Part 14: Pediatric Advanced Life Support

Part 14: Pediatric Advanced Life Support

No evidence for decreased incidence of aspiration after rapid sequence induction

Airway Management in Trauma

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