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Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia

Lyon, R, Perkins, ZB, Chatterjee, D, Lockey, DJ and Russell, MQ (2015) Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital trauma anaesthesia Critical Care, 19 (134).

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Abstract

Introduction: Rapid Sequence Induction of anaesthesia (RSI) is the recommended method to facilitate emergency tracheal intubation in trauma patients. In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using etomidate and suxamethonium with a modified RSI protocol using fentanyl, ketamine and rocuronium. Methods: We performed a comparative cohort study of major trauma patients undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using etomidate and suxamethonium and Group 2 underwent RSI using fentanyl, ketamine and rocuronium. Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality. Results: Compared to Group 1 (n = 116), Group 2 RSI (n = 145) produced significantly better laryngoscopy views (p = 0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p = 0.007). A hypertensive response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p < 0.0001). A hypotensive response was uncommon in both groups (1% versus 6%; p = 0.05). Only one patient in each group developed true hypotension (SBP < 90 mmHg) on induction. Conclusions: In a comparative, cohort study, pre-hospital RSI using fentanyl, ketamine and rocuronium produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital trauma anaesthesia.

Item Type: Article
Subjects : Health Sciences
Divisions : Faculty of Health and Medical Sciences
Authors :
AuthorsEmailORCID
Lyon, RUNSPECIFIEDUNSPECIFIED
Perkins, ZBUNSPECIFIEDUNSPECIFIED
Chatterjee, DUNSPECIFIEDUNSPECIFIED
Lockey, DJUNSPECIFIEDUNSPECIFIED
Russell, MQUNSPECIFIEDUNSPECIFIED
Date : 1 April 2015
Identification Number : 10.1186/s13054-015-0872-2
Copyright Disclaimer : © 2015 Lyon et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Depositing User : Symplectic Elements
Date Deposited : 04 May 2016 14:39
Last Modified : 04 May 2016 14:39
URI: http://epubs.surrey.ac.uk/id/eprint/810627

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