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Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (The ENDAO Trial)
Author(s) -
Caputo Nicholas,
Azan Ben,
Domingues Rui,
Donner Lee,
Fenig Mark,
Fields Douglas,
Fraser Robert,
Hosford Karlene,
Iuorio Richard,
Kanter Marc,
McCarty Moira,
Parry Thomas,
Raja Andaleeb,
Ryan Mary,
Williams Blaine,
Sharma Hemlata,
Singer Daniel,
Shields Chris,
Scott Sandra,
West Jason R.
Publication year - 2017
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13274
Subject(s) - medicine , intubation , anesthesia , hypoxemia , apnea , confidence interval , emergency department , randomization , randomized controlled trial , oxygen saturation , oxygenation , population , surgery , oxygen , chemistry , environmental health , organic chemistry , psychiatry
Objectives Desaturation leading to hypoxemia may occur during rapid sequence intubation ( RSI ). Apneic oxygenation ( AO ) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care ( UC ) in the emergency setting. Methods A randomized controlled trial was conducted at an academic, urban, Level I trauma center. All patients requiring intubation were included. Exclusion criteria were patients in cardiac or traumatic arrest or if preoxygenation was not performed. An observer, blinded to study outcomes and who was not involved in the procedure, recorded all times, while all saturations were recorded in real time by monitors on a secured server. Two‐hundred patients were allocated to receive AO ( n = 100) or UC ( n = 100) by predetermined randomization in a 1:1 ratio. Results A total of 206 patients were enrolled. There was no difference in lowest mean oxygen saturation between the two groups (92, 95% confidence interval [ CI ] = 91 to 93 in AO vs. 93, 95% CI = 92 to 94 in UC ; p = 0.11). Conclusion There was no difference in lowest mean oxygen saturation between the two groups. The application of AO during RSI did not prevent desaturation of patients in this study population.