Rapid-sequence intubation at an emergency medicine residency: Success rateand adverse events during a two-year period

Objectives: Rapid-sequence intubation (RSI) is an active airway interventio n used frequently in emergency medicine (EM). The authors hypothesized that RSI can be performed safely in the setting of an EM training program at a tertiary care center. Methods: Observational study of RSI at an urban ED/Le vel 1 trauma center with annual census of 100,000 patients. Consecutive pat ients who underwent RSI during a two-year period were studied. Data include d age, gender, type of patient (medical/trauma), indication for intubation, number of intubation attempts (laryngoscope passes), training level of ope rator, and major immediate adverse events (clinical deterioration within 10 minutes of RSI). Results: RSI was used in 417 of 596 (70%) critically ill patients requiring emergent intubation. The patient demographic distributio n was the following: adults 89.7%, male 58%, and trauma 44%. Primary indica tions for intubation among RSI patients were as follows: mechanical ventila tion 57.4%, airway protection 41.3%, and cardiac arrest 1.3%. Distribution of intubations by level of EM training was PGY1, 5%; PGY2, 52%; PGY3, 40%; and attendings, 3%. Intubations were successfully completed within two atte mpts in 97% of the patients. Major immediate adverse events were encountere d in six patients (1.4%) (hypotention = 2, hypoxemia = 1, dysrhythmia = 3). There was no death attributable to RSI. The rate of intubations requiring two or fewer attempts and without major immediate adverse events was 96%. T hree patients required cricothyrotomy. Conclusion: In the setting of an EM residency at a tertiary care ED, RSI can be performed successfully with few major immediate adverse events.