873: Rapid Sequence Intubation Compared to Non-RSI for... : Critical Care Medicine (2024)

Introduction: Rapid Sequence Intubation (RSI) has been the preferred technique for out-of-OR intubations due to the improved grade of glottic view and overall intubating conditions when using direct laryngoscopy. Given the design of video laryngoscopes (VL), the benefit of RSI may not be as significant, as the view of the glottic inlet is from a camera positioned on the distal undersurface of the blade. To date, no literature exists evaluating the effect of RSI with video laryngoscopy. This project will determine the effect of RSI vs. sedation only/no medications (non-RSI) on the first attempt success for VL intubations in the emergency department (ED) and medical intensive care unit (ICU). Methods: This was a retrospective analysis of a prospectively collected QI database. All intubations in the ED or ICU over a 12-month period at an academic medical center were included. The intubator completed a standardized form, which included patient demographics and detailed patient and procedure related information. All adult patients intubated with VL (CMAC or GlideScope) were included in this analysis. The primary outcome was first attempt success. Secondary outcome was any procedurally related complication. A multivariate logistic regression analysis was performed to adjust for potential confounders. Results: 443 intubations were performed using VL during the study period. 238 (54%) were performed in the ED, 205 (46%) were performed in the ICU (p=ns). 360 (81%) were intubated with RSI while 83 (19%) were intubated without a paralytic. 200 patients (45%) were intubated with a GlideScope, 243 (55%) with a CMAC (p=ns). There was no significant overall difference in first attempt success rate between devices (CMAC 78%, GlideScope 78%, p=ns). RSI had a higher first attempt success rate than non-RSI (82% vs. 63%)(p=0.<001). There was no significant difference in the percentage of patients with at least 1 complication (RSI 5.28%, non-RSI 1.2%, p=ns). A multivariate regression model controlling for difficult airway predictors and level of training of the intubator shows improved odds of success with RSI vs. non-RSI (adjusted OR 3.01 95%CI 1.71-5.23). Conclusions: These data for out-of-OR intubations suggest that RSI has improved odds of successful first attempt intubation when using a VL with no increase in procedurally related complications compared to noRSI, even when controlled for difficult airway predictors and level of training of the intubator.