Succinylcholine-assisted intubations in prehospital care

Hedges, Jerris R.; Dronen, Steven C.; Feero, Stan; Hawkins, Stephanie; Syverud, Scott A.; Shultz, Bette

doi:10.1016/s0196-0644(88)80238-5

Cited by 116 publications

(37 citation statements)

References 8 publications

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“…The use of neuromuscular blocking agents has been touted by our trauma and emergency department colleagues to improve intubating conditions and the percentage of successful tracheal intubations [16][17][18]. Airway management has been described as being more difficult without these agents under emergent conditions, although 80% of the patients in this database were intubated with no medication, topical anesthesia, or sedative-hypnotics alone.…”

Section: Discussionmentioning

confidence: 99%

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity

Mort

2005

Journal of Clinical Anesthesia

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Section: Discussionmentioning

confidence: 99%

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity

Mort

2005

Journal of Clinical Anesthesia

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“…Hedges et al reported in 1988 the use of succinylcholine in a ground paramedic system with a success rate of 96% and an adverse event rate of 21%. 23 Syverud et al found a success rate of 96% with the use of paralytics by an out-of-hospital physician -nurse team with an adverse event rate of 28%. 24 Murphy-Macabobby et al found an intubation success rate of 93% within two attempts and 100% within three attempts in 119 aeromedical patients requiring neuromuscular blockade-assisted intubation.…”

Section: Discussionmentioning

confidence: 99%

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Tayal

Riggs

Marx

et al. 1999

Academic Emergency Medicine

201

142

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Abstract. Objectives: Rapid-sequence intubation (RSI) is an active airway intervention used frequently in emergency medicine (EM). The authors hypothesized that RSI can be performed safely in the setting of an EM training program at a tertiary care center. Methods: Observational study of RSI at an urban ED/Level 1 trauma center with annual census of 100,000 patients. Consecutive patients who underwent RSI during a two-year period were studied. Data included age, gender, type of patient (medical/ trauma), indication for intubation, number of intubation attempts (laryngoscope passes), training level of operator, and major immediate adverse events (clinical deterioration within 10 minutes of RSI). Results: RSI was used in 417 of 596 (70%) critically ill patients requiring emergent intubation. The patient demographic distribution was the following: adults 89.7%, male 58%, and trauma 44%. Primary indications for intubation among RSI patients were as follows: mechanical ventilation 57.4%, airway protection 41.3%, and cardiac arrest 1.3%. Distribution of intubations by level of EM training was PGY1, 5%; PGY2, 52%; PGY3, 40%; and attendings, 3%. Intubations were successfully completed within two attempts in 97% of the patients. Major immediate adverse events were encountered in six patients (1.4%) (hypotention = 2, hypoxemia = 1, dysrhythmia = 3). There was no death attributable to RSI. The rate of intubations requiring two or fewer attempts and without major immediate adverse events was 96%. Three patients required cricothyrotomy. Conclusion: In the setting of an EM residency at a tertiary care ED, RSI can be performed successfully with few major immediate adverse events. Key words: intubation; emergency; RSI; residency; adverse events; success rate. ACADEMIC EMERGENCY MEDICINE 1999; 6:31 -37 R APID-sequence intubation (RSI) continues to garner wide acceptance in the emergency setting.1,2 Advantages, such as decreased risk of aspiration, attenuation of intracranial pressure (ICP), avoidance of cardiovascular compromise, and increased patient comfort, have rendered RSI the method of choice for the emergency airway. 2 -7 In addition, RSI can facilitate the difficult intubation in combative patients.3,8 However, RSI is not without risk, particularly if the airway cannot be readily secured and adequate ventilation cannot be provided.

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“…3 4 Rapid sequence induction of anaesthesia and intubation (RSI) have been shown to be safe when performed by emergency physicians in hospital 5 6 but are predominantly carried out by anaesthetists in most UK accident and emergency (A&E) departments. Prehospital RSI is performed by aeromedical teams in the USA [7][8][9][10] but literature on prehospital anaesthesia in Britain is limited. 11 12 The Helicopter Emergency Medical Service (HEMS) attends to trauma patients in the Greater London area and provides a doctor capable of performing rapid sequence induction of anaesthesia and advanced airway skills.…”

mentioning

confidence: 99%

Prehospital rapid sequence induction by emergency physicians: Is it safe?

Mackay

Terris²,

Coats³

2001

Emergency Medicine Journal

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Objectives-To determine if there were differences in practice or intubation mishap rate between anaesthetists and accident and emergency physicians performing rapid sequence induction of anaesthesia (RSI) in the prehospital setting. Methods-All patients who underwent RSI by a Helicopter Emergency Medical Service (HEMS) doctor from 1 May 1997 to 30 April 1999 were studied by retrospective analysis of in-flight run sheets. Intubation mishaps were classified as repeat attempts at intubation, repeat drug administration and failed intubation. Results-RSI was performed on 359 patients by 10 anaesthetists (202 patients) and nine emergency physicians (157 patients). Emergency physicians recorded a larger number of patients as havingCormack and Lehane grade 3 or 4 laryngoscopy than anaesthetists (p<0.0001) but were less likely to use a gum elastic bougie to assist intubation (p=0.024). Patients treated by emergency physicians did not have a significantly diVerent pulse, blood pressure, oxygen saturation or end tidal CO 2 to patients treated by anaesthetists at any time after intubation. Emergency physicians were more likely to anaesthetise patients with a Glasgow Coma Score >12 than anaesthetists (p=0.003). There were two failed intubations (1%) in the anaesthetist group and four (2.5%) in the emergency physician group. Repeat attempts at intubation and repeat drug administration occurred in <2% of each group. Conclusions-RSI performed by emergency physicians was not associated with a significantly higher failure rate or an increased number of intubation mishaps than RSI performed by anaesthetists. Emergency physicians were able to safely administer sedative and neuromuscular blocking drugs in the prehospital situation. It is suggested that emergency physicians can safely perform rapid sequence induction of anaesthesia and intubation.

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Succinylcholine-assisted intubations in prehospital care

Cited by 116 publications

References 8 publications

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity

Esophageal intubation with indirect clinical tests during emergency tracheal intubation: a report on patient morbidity

Rapid‐sequence Intubation at an Emergency Medicine Residency: Success Rate and Adverse Events during a Two‐year Period

Prehospital rapid sequence induction by emergency physicians: Is it safe?

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