title: Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service.
abstract: OBJECTIVE
  The Greater Sydney Area Helicopter Emergency Medical Service undertakes in excess of 2,500 physician/paramedic out-of-hospital and interhospital retrievals each year, of which 8% require intubation. Emergency anesthesia of critically ill patients is associated with complications, including hypoxia. In July 2011, the service introduced apneic oxygenation with nasal cannulae to its emergency anesthesia standard operating procedure to reduce rates of desaturation during rapid sequence intubation. We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation in both out-of-hospital and interhospital retrievals.
  
  
  METHODS
  This was a retrospective study of prospectively collected airway registry data. Consecutive patients who underwent rapid sequence intubation by Greater Sydney Area Helicopter Emergency Medical Service personnel between September 2009 and July 2013, spanning the introduction of apneic oxygenation, were included for analysis (n=728). We compared patients who underwent rapid sequence intubation before the service introduced apneic oxygenation (n=310) with those who underwent it after its introduction (n=418). We evaluated the association between the introduction of apneic oxygenation and the incidence of desaturation.
  
  
  RESULTS
  During the study period, 9,901 missions were conducted with 728 rapid sequence intubations (310 pre- and 418 postapneic oxygenation). The introduction of apneic oxygenation was followed by a decrease in desaturation rates from 22.6% to 16.5% (difference=6.1%; 95% confidence interval 0.2% to 11.2%).
  
  
  CONCLUSIONS
  Introduction of apneic oxygenation was associated with decreased incidence of desaturation in patients undergoing rapid sequence intubation.
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Emergency Department, Royal North Shore Hospital, Sydney, Sydney, NSW, Australia. Electronic address: yashvi299@yahoo.co.uk.
authors.forename: Yashvi
authors.initials: Y
authors.lastname: Wimalasena
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Brian
authors.initials: B
authors.lastname: Burns
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
authors.forename: Cliff
authors.initials: C
authors.lastname: Reid
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ware
authors.affiliation: Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia.
authors.forename: Karel
authors.initials: K
authors.lastname: Habig
mesh_terms: D017732:Air Ambulances / Q000706:statistics & numerical data*; D001049:Apnea / Q000628:therapy; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009517:New South Wales / Q000453:epidemiology; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy / Q000379:methods / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010100:Oxygen