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Original Article
An observational survey of emergency department rapid sequence intubation
  1. J M Butler,
  2. M Clancy,
  3. N Robinson,
  4. P Driscoll
  1. 1North West Region, UK
  2. 2Southampton General Hospital, UK
  3. 3Wessex Region, UK
  4. 4Hope Hospital, Salford, UK
  1. Correspondence to: Mr Butler, Emergency Department, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK (jmb2{at}jmb2.freeserve.co.uk)

Abstract

Objectives—To study the current practice of rapid sequence intubations (RSIs) in four different emergency medicine training programmes in the UK.

Methods—Observational study design involving four regional training programmes (Wessex, North West, Yorkshire, Avon). Data were collected in real time using a previously piloted survey tool. Data were collected by specialist registrars in emergency medicine over a continuous 28 day period. Data collected included: indications for RSI; key timings of RSI procedures; details of RSI practitioner; complications and outcome of procedure.

Results—Data from 60 RSIs were recorded and collected. The majority of decisions to perform RSIs were made by emergency physicians (74% cases). Over 50% of the RSIs occurred after 4 pm. Emergency physicians performed 26% of RSIs although the majority were performed by anaesthetists. Most of the given indications for RSIs were based on an assessment of airway protection. Hypoxia was an uncommon reason for RSI in this study (5%). In two thirds of cases the time taken from the decision being made to perform an RSI, to the achievement of successful intubation, was greater than 20 minutes. No failed intubations were recorded, although six other complications (all minor problems) were recorded. There was no significant difference in the response times between anaesthetists and emergency physicians.

Conclusions—This study shows that emergency physicians are currently performing RSIs in emergency departments in the UK. It also suggests improvements could be made to patient care. In particular, standards of care should be agreed for the provision of RSI in the emergency department, including the personnel involved and the appropriate training of individuals. RSI activity in emergency departments in the UK should be audited nationally using an agreed audit tool.

  • rapid sequence intubation
  • anaesthesia

https://doi.org/10.1136/emj.18.5.343

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    Footnotes

    • Contributors

      Mr J M Butler was responsible for recruitment of study centres, data collection and analysis, critical review of the evidence and wrote the paper. Mr M Clancy initiated the study, developed the survey tool, was responsible for coordinating data collection and analysis and helped to write the paper. Mr N Robinson helped to develop and pilot the audit tool and was involved in data collection. Mr P Driscoll was involved in discussing core ideas, data analysis and contributed to the paper. Mr J M Butler and Mr M Clancy will act as guarantors for this paper.

    • Funding: none.

    • Conflicts of interest: none.