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

Dr Richard Lyon HEMS

Here is the open access paper!
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.

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