Significant modification of traditional rapid sequence induction improves safety and effectiveness of pre-hospital XXXX anaesthesia.

@entity1 @entity101 @entity1170 @entity3652 @entity3575 @entity4671 @entity2898 @entity551 @entity2900 @entity130
INTRODUCTION: @entity1170 (RSI) is the recommended method to facilitate emergency tracheal intubation in @entity130 @entity1 . In emergency situations, a simple and standardised RSI protocol may improve the safety and effectiveness of the procedure. A crucial component of developing a standardised protocol is the selection of induction agents. The aim of this study is to compare the safety and effectiveness of a traditional RSI protocol using @entity4671 and @entity2900 with a modified RSI protocol using @entity3575 , @entity3652 and @entity2898 . METHODS: We performed a comparative cohort study of major @entity130 @entity1 undergoing pre-hospital RSI by a physician-led Helicopter Emergency Medical Service. Group 1 underwent RSI using @entity4671 and @entity2900 and Group 2 underwent RSI using @entity3575 , @entity3652 and @entity2898 . Apart from the induction agents, the RSI protocol was identical in both groups. Outcomes measured included laryngoscopy view, intubation success, haemodynamic response to laryngoscopy and tracheal intubation, and mortality. RESULTS: Compared to Group 1 (n   =   116), Group 2 RSI (n   =   145) produced significantly better laryngoscopy views (p   =   0.013) and resulted in significantly higher first-pass intubation success (95% versus 100%; p   =   0.007). A @entity101 response to laryngoscopy and tracheal intubation was less frequent following Group 2 RSI (79% versus 37%; p   <   0.0001). A @entity551 response was uncommon in both groups (1% versus 6%; p   =   0.05). Only one @entity1 in each group developed true @entity551 (SBP   <   90  mmHg) on induction. CONCLUSIONS: In a comparative, cohort study, pre-hospital RSI using @entity3575 , @entity3652 and @entity2898 produced superior intubating conditions and a more favourable haemodynamic response to laryngoscopy and tracheal intubation. An RSI protocol using fixed ratios of these agents delivers effective pre-hospital @entity130 anaesthesia.
