Table 2

Relevant papers

Author, date and countryPatient groupStudy type (level of evidence)OutcomesKey resultsStudy weaknesses
Conroy et al, 2014,1 USAMajor trauma patients undergoing RSI in the ED before and after checklist was institutedRetrospective ‘before and after’ unmatched cohortVital signs postintubationNo significant differenceNo data on proportion of patients that received intervention (all intubations after institution of checklist were assumed to have used it). Outcome measures not specified in plan. 67% of intubations in comparison group were performed by ED doctors, 99% in intervention group.
Complications during intubationNo significant difference
MortalityNo significant difference
Shanmugasundaram et al, 2014,2 UKPatients undergoing intubation in the ED or ICU before (n=47) and after (n=52) a quality improvement initiative including use of a checklist.Retrospective ‘before and after’ unmatched cohortMajor adverse incidents (MAI) as defined by NAP4 criteria10.8% incidence of MAI preintervention, compared with 0% postintervention.Small size and no power calculation. Retrospective closed loop audit (conference abstract). Intervention comprised several changes, unable to clarify effect of checklist individually. Difficult to gauge proportional use of checklist during the intervention period.
Kerrey et al, 2015,3 USACritically ill children undergoing RSI in a paediatric ED, before and after institution of four quality improvement measures, including a checklist.Retrospective ‘before and after’ unmatched cohort studyIncidence of desaturation (SpO2 <90%) during RSIDesaturation occurred in 33% of historical controls vs 16% of intervention cohort. ARR 17% (95% CI 4% to 28%)Retrospective design. Multiple interventions studied at once, making if difficult to assess effect of checklist alone. Airway interventions restricted to certain operators as one aspect of the QI measures.
Smith et al, 2015,4 USAMajor trauma patients undergoing RSI in the ED before and after introduction of a preprocedural checklistProspective observational ‘before and after’ unmatched cohort studyComplications (composite outcome)Overall complication rate 1.5% in intervention group, 9.2% in control. ARR 7.7% (CI 0.5% to 14.8%)No power calculation. Composite outcome—individual outcome measures show no significant difference. Incomplete compliance with checklist in treatment cohort. Significant likelihood of Hawthorne effect contributing to improved outcome measure.
Paralysis to intubation timeMedian 92 s prechecklist, compared with 82 s postchecklist.
Adherence to recognised safety measures17.1% adherence prechecklist, improved to 69.2% postchecklist