Apnoeic Oxygenation: Essential in Prehospital RSI

This was a talk from the 2014 London Trauma Conference by Cliff Reid


How it works – review by Nicholas Chrimes

When it all started in #FOAMed in Dec 2010 – NODESAT article by Rich Levitan

We tried it and liked it, so introduced into our airway SOP in July 2011 (latest version written May 2012)

The definitive article by Scott Weingart & Rich Levitan in Annals (published online Nov 2011): Preoxygenation and prevention of desaturation during emergency airway management.

Not just in the EM literature – the principle described in 1959 in Anesthesiology: Apneic oxygenation in man

Other studies in anaesthetic literature, showing increased apnoea time in obese & non-obese subjects, including some RCTs – BestBET on apnoeic oxygenation

It’s on the Australaian ED airway registry form and every ED checklist I’ve seen

It’s recommended in the proposed critical care RSI operation procedure and checklist by Sherren

In prehospital care, “standards of practice and monitoring should be similar to those recommended for in-hospital anaesthesia” according to the AAGBI

It’s well tolerated and unlikely to lead to adverse effects

At Sydney HEMS, its use was associated with a decrease in desaturation (very conservatively defined as <93%, and included some already hypoxic patients prior to anaesthesia) from 22.6 to 16.9% – retrospective analysis of prospectively captured registry data accepted for publication in Annals of Emergency Medicine.

Do we need an RCT? – it would be nice but based on a power calculation it would take several years in our service and with observed improvements in our quality procuess we anticipate lower desaturation rates in the control group than historically shown, further increasing the number needed to show a difference, risking an underpowered inconclusive study after years of work. It might therefore be better to do a multicentre ED based study, although a low-cost, low-risk safety intervetion with good RCT data to support it from the anaesthesia literature may not require further evidence to support its use.

View the slides:

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1 Response to Apnoeic Oxygenation: Essential in Prehospital RSI

  1. Pingback: Prehospital anaesthesia | PHARM

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