Intubating Conditions Produced by Etomidate Alone vs Rapid Sequence Intubation in the Prehospital Aeromedical Setting

• Published in: Academic emergency medicine 2003-05, Vol.10 (5), p.445-446
• Main Author: Bozeman, W. P
• Format: Article
• Language: English
• ISSN: 1069-6563; 1553-2712
• DOI: 10.1197/aemj.10.5.445-b

OBJECTIVES: Intubating conditions are a better measure than eventually successful intubation rates when comparing intubation medication regimens. We sought to evaluate the intubation conditions produced by etomidate (Etom) sedation alone compared to those produced by rapid sequence intubation (RSI) with succinylcholine (Sux) and Etom. METHODS: A prospective crossover trial design used two helicopters staffed by the same flight crews. Each aircraft utilized an Etom intubation protocol of 20 mg adult dose with a second dose of Etom or rescue Sux available if needed for six months. RSI with the same dose of Etom plus Sux (1 mg/kg) was used for the other six months. Intubating conditions were graded at each attempt by three scales: 1) global difficulty using a Likert scale of 1 (very easy) to 5 (very difficult), 2) the Percentage Of Glottic Opening (POGO) score, and 3) formal Laryngoscopy Grading Scale (LGS) resulting in a "good," "acceptable" or "unacceptable" rating. Orotracheal intubation success was recorded at each dose. RESULTS: A total of 56 patients were intubated. Mean age was 39 years, 79% were male, and 88% were intubated for trauma. Conditions were assessed for all 69 laryngoscopy attempts. Laryngoscopy was performed after Etom 20 mg (n = 15), Etom 40 mg (n = 9), RSI (n = 31), and no meds or other (n = 14). Mean values after Etom or RSI were as follows for subjective difficulty, POGO score (% visualized), LGS resulting in either "good" or "acceptable" conditions, and orotracheal intubation success rate: Diff POGO LGS G/A Success RSI 3.1 59% 74% 90% Etom 40 4.4 17% 0% 44% Etom 20 4.9 9% 13% 13% Intubating conditions with RSI were significantly improved by all measures (p