Preoxygenation reduces desaturation events and improves intubation success.
OBJECTIVE
Oxygen desaturation occurs frequently in the course of prehospital rapid sequence intubation (RSI) and is associated with increased morbidity and mortality. Preoxygenation with positive pressure ventilation by bag valve mask may delay the onset of desaturation. The purpose of this study was to evaluate implementation of a targeted preoxygenation protocol including the use of positive pressure ventilation on desaturation events and intubation success during air medical RSI.


METHODS
The RSI air medical program airway training model was modified to target an oxygen saturation as measured by pulse oximetry value of ≥ 93% before initial laryngoscopy. A review of oxygen saturation as measured by pulse oximetry tracings was performed for 2 years before and 2 years after implementation of this protocol. The incidence of desaturation events and overall intubation success rates were compared before and after the intervention.


RESULTS
One hundred fifty-five RSI procedures were evaluated over the study period. Desaturation events decreased from 58% in the 2 years before algorithm changes to 28% in the first year and 14% in the second year after implementation (P < .01). Intubation success rates increased from 89% to 98% (P < .01). There were no self-reports of aspiration events during the study period.


CONCLUSIONS
A preoxygenation protocol dramatically reduced the incidence of desaturation events and increased intubation success without an increase in the number of reported aspiration events.
UC San Diego Emergency Medicine, La Jolla, CA; Air Methods Corporation, Englewood, CO.
Daniel P
DP
Davis
UC San Diego Emergency Medicine, La Jolla, CA.
Justin
J
Lemieux
UC San Diego Emergency Medicine, La Jolla, CA.
John
J
Serra
Air Methods Corporation, Englewood, CO; Long Beach Memorial Medical Center, Long Beach, CA.
William
W
Koenig
UC San Diego Emergency Medicine, La Jolla, CA; Kaiser Permanente, San Diego, CA. Electronic address: SteveAguilarMD@Gmail.com.
Steve A
SA
Aguilar
D017732:Air Ambulances; D002985:Clinical Protocols; D065187:Controlled Before-After Studies; D004632:Emergency Medical Services / Q000379:methods*; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000379:methods*; D007828:Laryngoscopy / Q000379:methods; D010092:Oximetry; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D011446:Prospective Studies