Park Sung-Yeol, Chon Sung-Bin
Department of Emergency Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea.
Rapid Response Center, CHA Bundang Medical Center, Seongnam, Korea.
Clin Exp Emerg Med. 2025 Jun;12(2):139-147. doi: 10.15441/ceem.24.227. Epub 2025 Jan 14.
Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI is underutilized outside emergency departments (EDs). We compared RSI adoption rates and ETI outcomes outside and within the EDs and investigated whether RSI adoption affected ETI outcomes outside the EDs.
This retrospective study included adults who underwent emergency ETI outside the operating room at one university hospital between March 2022 and February 2023. The exclusion criteria included cardiopulmonary resuscitation, intentional RSI avoidance, and tube exchange via an introducer. The primary outcome was first-pass success rate. Secondary outcomes were multiple attempts (≥3), prolonged ETI (>5 minutes), and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariate logistic regression.
A total of 490 ETI cases was included: 286 occurred outside the ED and 204 within the ED. The mean age was 68.3±14.7 years and 290 were male. Cases outside the ED received fewer RSI attempts than cases within the ED (12.6% vs. 86.8%, P<0.001). The former showed fewer incidents of first-attempt success (62.2% vs. 88.2%, P<0.001), more numerous multiple attempts (11.5% vs. 2.0%, P<0.001), longer total time of ETI (8.4±8.3 minutes vs. 2.5±2.5 minutes, P<0.001), and more frequent complications (32.2% vs. 19.6%, P=0.003). However, multivariate logistic regression revealed no significant association between RSI adoption and these outcomes outside the ED: odds ratio, 1.74 (95% confidence interval [CI], 0.783-3.84), 0.167 (95% CI, 0.022-1.30), 1.04 (95% CI, 0.405-2.69), and 1.50 (95% CI, 0.664-3.40), respectively.
Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.
快速顺序诱导插管（RSI）是指在气管插管（ETI）前给予诱导剂和神经肌肉阻滞剂。然而，RSI在急诊科以外的环境中未得到充分利用。我们比较了急诊科内外RSI的采用率和ETI结果，并调查了RSI的采用是否会影响急诊科以外环境中的ETI结果。
这项回顾性研究纳入了2022年3月至2023年2月期间在某大学医院手术室以外接受紧急ETI的成年人。排除标准包括心肺复苏、故意避免RSI以及通过引导器进行导管更换。主要结局是首次通过成功率。次要结局包括多次尝试（≥3次）、延长的ETI时间（>5分钟）和并发症。使用多变量逻辑回归评估RSI的采用与急诊科以外环境中结局之间的关联。
共纳入490例ETI病例：286例发生在急诊科以外，204例发生在急诊科内。平均年龄为68.3±14.7岁，男性290例。急诊科以外的病例接受RSI尝试的次数少于急诊科内的病例（12.6%对86.8%，P<0.001）。前者首次尝试成功的发生率较低（62.2%对88.2%，P<0.001），多次尝试的情况较多（11.5%对2.0%，P<0.001），ETI总时间较长（8.4±8.3分钟对2.5±2.5分钟，P<0.001），并发症更频繁（32.2%对19.6%，P=0.003）。然而，多变量逻辑回归显示RSI的采用与急诊科以外的这些结局之间无显著关联：优势比分别为1.74（95%置信区间[CI]，0.783-3.84）、0.167（95%CI，0.022-1.30）、1.04（95%CI，0.405-2.69）和1.50（95%CI，0.664-3.40）。
在急诊科以外，RSI的采用率较低，ETI结果比急诊科内更差。然而，未发现RSI的采用与急诊科以外的ETI结果之间存在关联。
