A Prospective Controlled of the Rapid Sequence Intubation Technique in the Emergency Department of a University Hospital
Mingkwan Wongyingsinn MD*, Usapan Surabenjawong MD**
Affiliation : * Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand ** Department of Emergency Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To compare the time taken to intubate, the number of intubation attempts, and incidence of complications in
patients undergoing rapid sequence intubation (RSI) with those intubated with non-RSI techniques in non-traumatic
emergency department.
Material and Method: A prospective controlled study of intubation in 224 adults, half were intubated using RSI and
half non-RSI. Patients’ demographic details, indication for intubation, intubation technique, decision-to-tube time, open
mouth-to-tube time, number of attempts, and immediate complications were recorded.
Results : The median open mouth-to-tube time was significantly lower in the RSI group (65 seconds [interquartile range,
IQR 44 to 92 seconds] vs. 127 seconds [IQR 70 to 274 seconds], p<0.01), but there was no difference in the median
decision-to-tube time (412 seconds [IQR 354 to 506 seconds] in the RSI group compared with 420 seconds [IQR 265 to
566 seconds] in the non-RSI group, p = 0.46). Intubation success rate was significantly higher in the RSI group (83.9%
compared with 54.5%, p<0.01), and was superior even for less experienced intubators. The incidence of immediate
complications was significantly lower in the RSI group (42.0%) than the non-RSI group (56.2%, p = 0.04).
Conclusion : Using RSI significantly reduced the time from laryngoscopy to confirmation of intubation, improved success
rate, and reduced the incidence of complications compared with non-RSI techniques. Furthermore, the RSI technique did
not prolong the time from decision-making to completion.
Keywords : Airway management, Intubation duration, Rapid sequence intubation
