ABSTRACTS
The Association Between Drug Assisted Airway Management and Peri-Intubation Adverse EventsAuthor: Anna Meyer BS, EMT-P | Medical Student, Paramedic | Lake Erie College of Osteopathic Medicine Associate Authors: Sauers, Robin, BS, EMT-P Lechevet, Ian, MPH, MSW, EMT-P Synder, Caleb, AAS, EMT-P Page, David, MS, EMT-P Jarvis, Jeffrey, MD, MS, EMT-P
Introduction: Drug Assisted Airway Management (DAAM) is commonly used for prehospital airway management. DAAM involves use of sedatives and/or paralytics to facilitate endotracheal intubation (ETI), including rapid sequence intubation (RSI), sedation-assisted intubation, and paralytic-only. While RSI has been associated with improved first-pass success (FPS), the effect of DAAM approach on peri-intubation adverse events remains uncertain. Therefore, we sought to evaluate the association between DAAM approach and adverse events following ETI in EMS patients. Methods: We performed a retrospective cohort study using the 2022 ESO research dataset. We included EMS encounters involving patients aged ≥10 with an intubation attempt without cardiac arrest. Analyzing only the first intubation attempt, we stratified patients into four groups based on medications given prior to ETI attempt: RSI, sedative-only, paralytic-only, or no medication. Our primary outcome was composite adverse events in the 10-minutes following the ETI attempt. We defined an adverse event as new onset hypoxemia or hypotension (<90% or <90mmHg) or ≥10% decrease of initial values if not initially abnormal. We calculated descriptive statistics and performed a general linear mixed-methods regression adjusting for age, gender, race, medical/trauma, laryngoscope (VL/DL), initial SpO2 and SBP, and presence of FPS, using agency as a random intercept, to evaluate associations between DAAM methods and composite adverse events. Results: 18,876 records met our inclusion criteria. The median age was 62 [IQR 45,74]. 59% were male and 75% were intubated for medical reasons. VL was used in 42% and 13.3% were initially hypoxemic or hypotension. The overall FPS was 74.5%. DAAM approaches included: no medication: 9,175(48.6%), paralytic-only: 204(1.1%), RSI: 7,006(37.1%), sedation-only: 2,491(13.2%). Because of small numbers of paralytic-only intubations, we excluded these from analysis. RSI and sedation-only, compared with no medications, were associated with increased odds of composite adverse events: RSI: aOR 1.49(95%CI 1.31-1.69), sedation-only: aOR 1.38(95%CI 1.18-1.61). These associations were consistent in sensitivity analyses that included paralytic-only as well as post-arrival cardiac arrest cases. Conclusion: Compared with no medications, the use of DAAM was associated with between 38% (sedation-only) and 49% (RSI) higher odds of peri-intubation hypoxemia or hypotension. This suggests an important opportunity for improvement.
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