Rapid sequence intubation of trauma patients in Scotland.
BACKGROUND
Endotracheal intubation remains the gold standard for trauma airway management. Rapid sequence intubation (RSI) has traditionally been performed by anesthesiologists but increasingly, emergency physicians are also undertaking RSI. We aimed to compare success and complication rates for trauma intubations for the two specialties.


METHODS
Two year, prospective multi-center descriptive study of trauma RSI in seven Scottish urban emergency departments.


RESULTS
439 trauma patients were identified, including 233 RSIs. Patients intubated by emergency physicians had a higher median ISS (p < 0.001) and lower median RTS (p < 0.001) compared with anesthesiologists. For RSI, anesthesiologists had more grade I & II views at laryngoscopy (p = 0.051) and more successful first attempt intubations (p = 0.034) but there was no difference in the number of patients suffering complications (emergency physicians 10.0%, anesthesiologists 10.6%).


CONCLUSIONS
There is no significant difference in complication rates for trauma RSI between emergency physicians and anesthesiologists in Scottish urban centers. A collaborative approach to the critical trauma airway is vital. Emergency physicians should consult with senior anesthesiologists before RSI when intubation is predicted to be difficult.
Graham
Colin A
CA
Emergency Medicine, Southern General Hospital, Glasgow, Scotland. cagraham@rcsed.ac.uk
Beard
Diana
D
Henry
Jennifer M
JM
McKeown
Dermot W
DW
D000328:Adult; D000776:Anesthesiology / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D016292:Procedural Sedation / Q000592:standards* / Q000706:statistics & numerical data; D004363:Drug Utilization; D004635:Emergency Medicine / Q000193:education / Q000592:standards* / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006784:Hospitals, Teaching; D006801:Humans; D015601:Injury Severity Score; D007442:Intubation, Intratracheal / Q000009:adverse effects / Q000592:standards* / Q000706:statistics & numerical data; D007828:Laryngoscopy / Q000592:standards / Q000706:statistics & numerical data; D008297:Male; D008485:Medical Audit; D009104:Multiple Trauma / Q000628:therapy*; D009466:Neuromuscular Blocking Agents / Q000627:therapeutic use*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012606:Scotland; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
D009466:Neuromuscular Blocking Agents