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Apnoeic oxygenation was associated with decreased desaturation rates during rapid sequence intubation in multiple Australian and New Zealand emergency departments
  1. Adrian Perera1,
  2. Hatem Alkouri2,3,
  3. Toby Fogg4,
  4. John Vassiliadis4,5,
  5. John Mackenzie6,
  6. Yashvi Wimalasena7,8
  1. 1Intensive Care, Royal Free London NHS Foundation Trust, London, UK
  2. 2Emergency Care Institute, New South Wales Agency for Clinical Innovation, Sydney, New South Wales, Australia
  3. 3Faculty of Medicine, University of New South Wales School of the Arts and Media, Sydney, New South Wales, Australia
  4. 4Emergency Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
  5. 5Medical Education, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
  6. 6Acute Care Adult and Paediatrics, Prince of Wales Hospital, Sydney, New South Wales, Australia
  7. 7Emergency Medicine, University Hospitals Coventry & Warwickshire NHS Trust, Birmingham, West Midlands, UK
  8. 8GSA HEMS, NSW Ambulance Service, Sydney, New South Wales, Australia
  1. Correspondence to Dr Adrian Perera, Emergency Department, Royal Free London NHS Foundation Trust, London NW3 2QG, UK; adrian_perera{at}


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
  • resuscitation
  • rsi
  • ventilation
  • invasive

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  • Handling editor Ellen J Weber

  • Twitter @perera_adrian

  • 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.

  • Patient consent for publication Not required.

  • Ethics approval The Northern Sydney Local Health District Human Research Ethics Committee approved this study in 2012 (ID: 1209-318M).

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

  • 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.

  • 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.

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