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

Kudos to Dr Richard Lyon and colleagues to publish this useful prehospital paper!

My comments:

Significantly better 1st pass success in the fentanyl/ketamine/rocuronium group vs etomidate/suxamethonium group, likely due to better direct laryngoscopic views. Uncertain reason for the difference given cohort study, using before/after methodology. Possible confounders include operator bias, operator performance over time
Mortality rates the same between groups with no difference when analysed for only head injury related deaths
Low rates of perintubation hypotension overall
100% 1st pass success is pretty impressive, which makes me wonder if the improvement was operator performance over time, rather than drug effect per se.