Human factors in the emergency department: Is physician perception of time to intubation and desaturation rate accurate?

Abstract

Our findings have shown that provider's perception of TTI occurs sooner than actually observed. Also, the providers were less aware of desaturation during the procedure.

Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (The ENDAO Trial)

“…Eligible patients were randomly assigned in a 1:1 ratio to receive AO (intervention) or UC (control). The sequence of study group assignments was generated via a computerized algorithm using permuted blocks of 4, 8, and 12 . Study group assignments were placed in a secured binder and sequentially numbered in opaque envelopes.…”

Is adequate preoxygenation about more than just 3 minutes?

“…In fact, we know that periintubation hypoxia is both common and harmful in both the emergency department (ED) and emergency medical services (EMS) settings. [1][2][3][4][5][6][7][8] Preoxygenation is aimed at denitrogenation and maximization of an oxygen "buffer" in the functional residual capacity to decrease the risk of peri-intubation hypoxia. 9 Common practice in emergency settings to achieve adequate preoxygenation is to ensure SpO 2 levels > 93% for at least 3 minutes.…”

Measuring Intubation in the Emergency Department: Is It Time to Include End‐tidal Carbon Dioxide to Determine the Onset of Apnea?

“…Our ED has addressed the issue of human factors in determining the time of intubation and the use of end‐tidal CO 2 , which suggests an advantage of 20 seconds versus clinical gestalt to determine the onset of apnea during ED RSI. Finally, I understand that adding an additional quantitative tool to help measure the onset of apnea may increase the complexity of tracheal intubation in the ED, but considering that seconds matter for our most critically ill patients undergoing RSI in the ED, I recommend that future ED airway studies intending to measure intubation times also include the use of end‐tidal CO 2 measurements to best measure the onset of apnea.…”