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Temporal changes in blood pressure following prehospital rapid sequence intubation
  1. Pieter Francsois Fouche1,
  2. Ben Meadley2,3,
  3. Toby StClair4,5,
  4. Alison Winnall6,
  5. Christopher Stein7,
  6. Paul Andrew Jennings5,6,
  7. Stephen Bernard6,
  8. Karen Smith6,8
  1. 1 Department of Paramedicine, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, Victoria, Australia
  2. 2 Paramedicine, Monash University Faculty of Medicine Nursing and Health Sciences, Frankston, Victoria, Australia
  3. 3 Air Ambulance, Ambulance Victoria, Doncaster, Victoria, Australia
  4. 4 Ambulance Victoria, Melbourne, Victoria, Australia
  5. 5 Department of Paramedicine, Monash University, Melbourne, Victoria, Australia
  6. 6 Ambulance Victoria, Doncaster, Victoria, Australia
  7. 7 Emergency Medical Care, University of Johannesburg, Johannesburg, Gauteng, South Africa
  8. 8 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  1. Correspondence to Dr Pieter Francsois Fouche, Department of Community Emergency Health and Paramedic Practice, Monash University Faculty of Medicine Nursing and Health Sciences, Clayton, VIC 3800, Australia; pfouche{at}


Background Rapid Sequence intubation (RSI) is an airway procedure that uses sedative and paralytic drugs to facilitate endotracheal intubation. It is known that RSI could impact blood pressure in the peri-intubation period. However, little is known about blood pressure changes in longer time frames. Therefore, this analysis aims to describe the changes in systolic blood pressure in a large cohort of paramedic-led RSI cases over the whole prehospital timespan.

Methods Intensive Care Paramedics in Victoria, Australia, are authorised to use RSI in medical or trauma patients with a Glasgow Coma Scale <10. This retrospective cohort study analysed data from patientcare records for patients aged 12 years and above that had received RSI, from 1 January 2008 to 31 December 2019. This study quantifies the systolic blood pressure changes using regression with fractional polynomial terms. The analysis is further stratified by high versus Low Shock Index (LSI). The shock index is calculated by dividing pulse rate by systolic blood pressure.

Results During the study period RSI was used in 8613 patients. The median number of blood pressure measurements was 5 (IQR 3–8). Systolic blood pressure rose significantly by 3.4 mm Hg (p<0.001) and then returned to baseline in the first 5 min after intubation for LSI cases. No initial rise in blood pressure is apparent in High Shock Index (HSI) cases. Across the whole cohort, systolic blood pressure decreased by 7.1 mm Hg (95% CI 7.9 to 6.3 mm Hg; p<0.001) from the first to the last blood pressure measured.

Conclusions Our study shows that in RSI patients a small transient elevation in systolic blood pressure in the immediate postintubation period is found in LSI, but this elevation is not apparent in HSI. Blood pressure decreased over the prehospital phase in RSI patients with LSI, but increased for HSI cases.

  • anaesthesia
  • airway
  • paramedics

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  • Handling editor Caroline Leech

  • Twitter @ben_meadley

  • Contributors PFF conceived of the study, KS and PFF collected data and PFF analysed all data. All authors contributed to the manuscript. PFF took responsibility for the paper as a whole.

  • Funding The authors have 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; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.