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Crit Care. 2015 Apr 1;19:134. doi: 10.1186/s13054-015-0872-2.

Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia.

Author information

1
Kent, Surrey and Sussex Air Ambulance Trust, Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent, TN12 9QJ, UK. RichardL@kssairambulance.org.uk.
2
Kent, Surrey and Sussex Air Ambulance Trust, Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent, TN12 9QJ, UK. zane.perkins@nhs.net.
3
Centre for Trauma Sciences, Queen Mary, University of London, London, E1 2AT, UK. zane.perkins@nhs.net.
4
Kent, Surrey and Sussex Air Ambulance Trust, Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent, TN12 9QJ, UK. djchatterjee@hotmail.com.
5
School of Clinical Sciences University of Bristol & University of Stavanger Norway, North Bristol NHS Trust, Bristol, BS16 1LE, UK. David.Lockey@nbt.nhs.uk.
6
Kent, Surrey and Sussex Air Ambulance Trust, Wheelbarrow Park Estate, Pattenden Lane, Marden, Kent, TN12 9QJ, UK. MalcolmRussell@kssairambulance.org.uk.

Abstract

INTRODUCTION:

Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium.

METHODS:

We performed a comparative cohort study of major trauma patients undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using etomidate and suxamethonium and Group 2 underwent RSI using fentanyl, ketamine and rocuronium. Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality.

RESULTS:

Compared to Group 1 (n = 116), Group 2 RSI (n = 145) produced significantly better laryngoscopy views (p = 0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p = 0.007). A hypertensive response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p < 0.0001). A hypotensive response was uncommon in both groups (1% versus 6%; p = 0.05). Only one patient in each group developed true hypotension (SBP < 90 mmHg) on induction.

CONCLUSIONS:

In a comparative, cohort study, pre-hospital RSI using fentanyl, ketamine and rocuronium produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital trauma anaesthesia.

PMID:
25879683
PMCID:
PMC4391675
DOI:
10.1186/s13054-015-0872-2
[Indexed for MEDLINE]
Free PMC Article

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