title: Apneic Oxygenation May Not Prevent Severe Hypoxemia During Rapid Sequence Intubation: A Retrospective Helicopter Emergency Medical Service Study.
abstract: OBJECTIVE
  This study sought to determine the effectiveness of apneic oxygenation in preventing hypoxemia during prehospital rapid sequence intubation (RSI).
  
  
  METHODS
  We performed a case-cohort study using a pre-existing database looking at intubation management by a single helicopter emergency medical service between July 2013 and June 2015. Apneic oxygenation using high-flow nasal cannula (15 L/min) was introduced to the standard RSI protocol in July 2014. Severe hypoxemia was defined as an incidence of oxygen saturation less than 90%. We compared patients who received apneic oxygenation during RSI with patients who did not using the Fisher exact test.
  
  
  RESULTS
  Ninety-three patients were identified from the database; 29 (31.2%) received apneic oxygenation. Nineteen patients had an incidence of severe hypoxemia during RSI (20.43%; 95% confidence interval, 12.77%-30.05%). There was no statistically significant difference between the rate of severe hypoxemia between patients in the apneic oxygenation group versus the control group (17.2% vs. 21.9%, P = .78).
  
  
  CONCLUSIONS
  In this study, patients who received apneic oxygenation did not show a statistically significant difference in severe hypoxemia during RSI.
authors.affiliation: Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA; Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand. Electronic address: sattha.riy@mahidol.ac.th.
authors.forename: Sattha
authors.initials: S
authors.lastname: Riyapan
authors.affiliation: Department of Emergency Medicine, Penn State Hershey Medical Center, Hershey, PA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Lubin
mesh_terms: D000328:Adult; D000368:Aged; D017732:Air Ambulances; D001049:Apnea; D016022:Case-Control Studies; D006259:Craniocerebral Trauma / Q000628:therapy; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000517:prevention & control*; D007442:Intubation, Intratracheal / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy; D010102:Oxygen Inhalation Therapy / Q000379:methods*; D012121:Respiration, Artificial / Q000379:methods; D012189:Retrospective Studies; D020521:Stroke / Q000628:therapy; D013898:Thoracic Injuries / Q000628:therapy