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Open Access

Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation

Jason Randall West, Brandon P O'Keefe, James T Russell
DOI: 10.1136/tsaco-2020-000588 Published 30 June 2021
Jason Randall West
1Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA
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Brandon P O'Keefe
1Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA
2Emergency Medicine, Maimonides Medical Center, Brooklyn, NY, USA
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James T Russell
1Emergency Medicine, NYC Health + Hospitals / Lincoln, Bronx, New York, USA
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Article Figures & Data

Tables

  • Table 1

    Patient demographics, injury severity, physiological variables, intubating operator level of training, periprocedural oxygenation, neuromuscular blocking agent, and device used for laryngoscopy

    First pass success without hypoxemia n=167No first pass success without hypoxemia n=79Difference (95% CI)P value
    Age (mean)3644−8 (−3.3 to −12.7)0.001
    ISS (mean)3431−2.9 (−7.8 to 2.2)0.25
    GCS (mean)109.3−0.7 (−1.9 to 0.5)0.25
    GCS, median (IQR)11 (6, 14)9 (6, 13.5)
    GCS score 13–15 (n)73 (43.7%)23 (29.1%)14.6% (2.1 to 27.1)0.03
    Heart rate (mean)10093−6.7 (−13.9 to 0.4)0.06
    Systolic BP (mean)133131−2.0 (−10.7 to 6.7)0.65
    Respiratory rate (mean)21210.05 (−2.0 to 2.0)0.99
    Head or facial injury (n)76 (46%)32 (40%)5.0% (−8.2 to 18.2)0.38
    Penetrating injury (n)48 (28.7%)15 (18.9%)9.8% (−2.0 to 20)0.10
    Operator training level (n)
     Attending45 (27%)19 (24%)3% (−9.1 to 13.8)0.62
     EM PGY 416 (10%)4 (5%)5% (−3.1 to 11.2)0.19
     EM PGY 329 (17%)18 (23%)−5.4% (−16.3 to 5.5)0.26
     EM PGY 249 (29%)20 (25%)4.0% (−7.8 to 15.8)0.51
     EM PGY 128 (17%)18 (23%)−6.0% (−17.5 to 4.1)0.26
    Oxygen saturation
     O2 pre-RSI (mean)97%97%−0% (−2 to 2)0.99
     Hypoxemia at confirmation (n)0 (0%)59 (75%)75% (65 to 84)<0.0001
     O2 at time of confirmation (mean)96%85%−11% (−12 to −8.3)<0.0001
    Laryngoscopic device (n)
     Direct159 (95%)77 (97%)−2.3% (−7 to 2.5)0.47
     Video8 (5%)2 (2.5%)2.3% (−2.5 to 7)0.36
    NMBA (n)
     Succinylcholine121 (72.5%)44 (55.7%)16.8% (4.1 to 29.4)0.01
     Rocuronium46 (27.5%)35 (44.3%)−16.8% (−4.1 to −29.4)0.01
    • O2=SpO2. Hypoxemia=SpO2<90%. O2 pre-RSI=most recent SpO2 obtained before the RSI medications were administered. O2 at time of confirmation=the lowest SpO2 after induction and within 2 min after confirmation of intubation.

    • BP, blood pressure; EM, emergency medicine; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; NMBA, neuromuscular blocking agent; RSI, rapid sequence intubation.

  • Table 2

    Multivariate logistic regression analysis for first pass success without hypoxemia among trauma patients requiring emergent tracheal intubation

    Adjusted OR95% CIP value
    NMBA
     RocuroniumReference
     Succinylcholine2.11.2 to 3.80.014
    Hypoxia
     No hypoxemia prior to RSIReference
     Hypoxemia prior to RSI1.70.5 to 6.10.395
    GCS score
     3–12Reference
     13–151.81.0 to 3.30.049
    Head or facial injury
     No head or facial injuryReference
     Head or facial injury1.30.7 to 2.20.445
    Level of training
     PGY 1–2Reference
     PGY 3 or greater1.10.6 to 1.80.867
    • Hypoxemia=SpO2< 90%. Hypoxemia prior to RSI=most recent SpO2 obtained before the RSI medications were administered.

    • GCS, Glasgow Coma Scale; NMBA, neuromuscular blocking agent; RSI, rapid sequence intubation.

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Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation
Jason Randall West, Brandon P O'Keefe, James T Russell
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000588; DOI: 10.1136/tsaco-2020-000588

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Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation
Jason Randall West, Brandon P O'Keefe, James T Russell
Trauma Surg Acute Care Open Jun 2021, 6 (1) e000588; DOI: 10.1136/tsaco-2020-000588
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Predictors of first pass success without hypoxemia in trauma patients requiring emergent rapid sequence intubation
Jason Randall West, Brandon P O'Keefe, James T Russell
Trauma Surgery & Acute Care Open Jun 2021, 6 (1) e000588; DOI: 10.1136/tsaco-2020-000588
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