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Studying ApOx in the ED: forget associations, the truth is in the design
  1. Nicholas Caputo
  1. Emergency Medicine, NYC Health+Hospitals/Lincoln, Bronx, New York, USA
  1. Correspondence to Dr Nicholas Caputo, Emergency Medicine, NYC Health+Hospitals/Lincoln, Bronx, NY 10451, USA;{at}

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Apnoeic oxygenation (ApOx) is an adjunctive airway technique that has been used over the decades to prevent desaturation during the apnoea period of rapid sequence intubation (RSI). The technique has made its way from the operating room to the prehospital environment to the emergency room (ER). Many studies, mostly observational, have looked at the efficacy of ApOx in delaying desaturation with a consensus that it does so and even a misunderstanding that it prevents it. This is despite the conflicting evidence of true efficacy (ie, reduction of not only desaturation rates, but morbidity and mortality). When looking back at the original study that laid the foundation for the physiological basis of ApOx, a question must be asked of the current technique used to perform the physiological manoeuvre at present: have we extrapolated the technique of that study to the point that we are actually performing something less efficacious?

The original study by Frumin et al of ApOx used significant preoxygenation periods (around 30 min), followed by induction, then endotracheal intubation, then subsequent paralysis to initiate apnoea.1 The findings of this study made clear the physiologically sound concept when performed with the proper technique. A distinction between the ED and the operating room in terms of the patient population served (undifferentiated patients in or close …

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  • Handling editor Ellen J Weber

  • Twitter @nickmd1980

  • Contributors NC is the sole author of this letter.

  • Funding The author has not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.