Apnoeic oxygenation (ApOx) has been demonstrated to reduce the incidence of desaturation, although evidence of benefit has been conflicting depending on the technique used. The aim of this study was to compare the incidence of desaturation between patients who received ApOx via conventional nasal cannula (NC) and those who did not, using a large, multicentre airway registry.
Methods This study is an analysis of 24 months of prospectively collected data in the Australia and New Zealand Emergency Department Airway Registry (June 2013–June 2015). The registry includes information on all intubated adults from 43 emergency departments. Patients intubated during cardiac arrest (n=393), those who received active ventilation prior to the first intubation attempt (n=486), and where the use of ApOx was not recorded either way (n=312) were excluded. The proportion of patients who desaturated (Sa02 <93) in the group that received ApOx and those that did not were compared. To evaluate the association of ApOx with patient desaturation, a logistic regression model based on factors expected to influence desaturation was performed.
Results Of 2519 patients analysed, 1669 (66.3%) received ApOx via NC while 850 (33.7%) did not. Desaturation in the cohort receiving ApOx was 10.4% compared with standard care (no ApOx) 13.7%. ApOx had a protective effect for desaturation (OR 0.71 95% CI 0.53 to 0.95). Single intubation attempt was associated with reduced risk of desaturation of (OR 0.10, 95% CI 0.06 to 0.17); this was increased on second attempt (OR 0.37, 95% CI 0.21 to 0.68). Desaturation was also associated with the physician recording that they had anticipated a difficult airway (OR 1.83, 95% CI 1.34 to 2.48).
Conclusion This large multicentre registry study provides evidence that ApOx delivered through a conventional NC is associated with a lower incidence of desaturation in patients undergoing rapid sequence intubation.
Trial registration number ACTRN12613001052729.
- anaesthesia - rsi
- intensive care
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information. Further data available on request to ANZEDAR through the Emergency Care Institute.
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Handling editor Ellen J Weber
Correction notice This paper has been revised to revise author affiliations, amend second author’s name to ‘Hatem Alkhouri’, and update ORCiD details. In the results section of this paper, the percentage of patients that desaturated has been updated to 13.7 %. This was previously listed incorrectly as 38%.
Collaborators Sally McCarthy; Matthew Murray; Maysaa Daher; Helen Badge.
Contributors YW prosed the subgroup analysis. HA, TF, JV, JM were involved in data generation and establishment of ANZEDAR. AP and HA prepared the manuscript, data analysis and submission. All listed authors partook in several stages of the review and preparation of the submitted manuscript.
Funding The Agency of Clinical Innovation through the Emergency Care Institute (ECI) research-funding scheme funded this project.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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