Apneic Oxygenation Including Precipitous Intubations During RSI in the ED
- Conditions
- Endotracheal IntubationApneic Oxygenation
- Interventions
- Other: Apneic oxygenation during endotracheal intubation
- Registration Number
- NCT03694379
- Lead Sponsor
- Rutgers, The State University of New Jersey
- Brief Summary
This RCT is testing the efficacy of apneic oxygenation during endotracheal intubation in the emergency department. Currently the standard practice in the ED when performing endotracheal intubation is that some providers use apneic oxygenation (the application of a nasal cannula at 15LPM) throughout the intubation procedure, while others do not apply apneic oxygenation. Initial literature in the operating room showed that apneic oxygenation helps prevent desaturation during the procedure. However, the latest literature conducted in critical care settings (one study in the ICU and one in the ED) questions the efficacy of this intervention in critically ill patients; however, no harm has been shown. Our study aims to test this intervention further by adding in a special subset of patients that was excluded from prior studies, precipitous intubations, or those patients that have to be intubated quickly and cannot have adequate pre-oxygenation. We hypothesize that apneic oxygenation will be more efficacious in this subset than in the overall ED population. We will randomize patients requiring endotracheal intubation into intervention (apneic oxygenation) and control (no apneic oxygenation). We will measure the lowest arterial oxygen saturation from the start of the intubation procedure through 2 minutes after intubation is complete.
- Detailed Description
Not available
Recruitment & Eligibility
- Status
- TERMINATED
- Sex
- All
- Target Recruitment
- 10
- The inclusion criteria for our study will include patients 18 years or older who require emergent endotracheal intubation utilizing rapid sequence intubation (RSI) in the Emergency Department with first attempt taken by a resident or attending physician working in the emergency department. This includes Emergency Medicine attending physicians and residents as well as non-Emergency Medicine rotators (e.g.., Internal Medicine residents who are rotating through the Emergency Department).
- Exclusion criteria include patients who are in cardiac arrest, or if the patient received any positive pressure ventilation (i.e, BPAP, CPAP, BVM) in the emergency department before RSI.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Apneic Oxygenation Apneic oxygenation during endotracheal intubation Participants receiving apneic oxygenation
- Primary Outcome Measures
Name Time Method Lowest oxygen saturation overall Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation Lowest oxygen saturation between overall control and intervention groups
- Secondary Outcome Measures
Name Time Method Difference in baseline and final oxygen saturation Decision to intubate through 2 minutes after completion of endotracheal intubation Desaturation Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation The proportion of patients who desaturate below 90%
Hospital length of stay Up to 28 days after intubation Number of days patient is hospitalized
Number of days intubated Up to 28 days after intubation Lowest oxygen saturation precipitous intubations Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation Lowest oxygen saturation between control and intervention groups that did not receive adequate pre-oxygenation only
Need for second operator From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. A second physician had to attempt intubation
In-hospital mortality Up to 28 days after intubation Difference in oxygen saturation before and after apneic period Initiation of neuromuscular blockade through 2 minutes after completion of endotracheal intubation Procedural hypotension Initiation of neuromuscular blockade to 2 minutes after completion of endotracheal intubation Proportion of became hypotensive at any point during the intubation procedure
Need for additional intubating equipment From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. The operator needed to change or add equipment to facilitate intubation
Aspiration Within 24 hours after intubation procedure was complete Proportion of patients that had evidence of aspiration
Lowest oxygen saturation pre-oxygenation Time between neuromuscular blockade and 2 minutes after completion of endotracheal intubation Lowest oxygen saturation between control and intervention groups that did receive
number of attempts From first attempt at intubation through completion of endotracheal intubation procedure, approximately 2 minutes. number of times laryngoscope is placed into the mouth in an attempt to pass an endotracheal tube
Esophageal intubations From first attempt at intubation through entire ED stay, approximately 6 hours. The proportion of intubations that resulted in the endotracheal tube being placed in the esophagus
Trial Locations
- Locations (1)
University Hospital
🇺🇸Newark, New Jersey, United States