Incidence of adverse events during prehospital rapid sequence intubation: a review of one year on the London Helicopter Emergency Medical Service.

BACKGROUND: To establish the incidence of hypoxemia and hypotension during prehospital rapid sequence intubation (RSI) in trauma patients attended by the London Helicopter Emergency Medical Service (HEMS) and to compare it with historical control data from published studies of both hospital and prehospital RSI.

METHODS: A retrospective observational study during a 12-month period of London HEMS. All mission reports from the period March 1, 2003 to February 28, 2004 were reviewed and all intubations involving the use of drugs were included in the analysis. Measurements of oxygen saturation (SpO2) and systolic blood pressure (SBP) were obtained from the printed record produced by the portable monitor.

RESULTS: During the 12-month period 244 RSIs were performed. Completed SpO2 data were available on 175 patients (71.7%), and of those 32 (18.3%) experienced hypoxemia (SpO2 <90%, or >10% fall if initial SpO2 <90%). Completed SBP data were available for 192 patients (79.1%), and of those 25 (13%) experienced hypotension (SBP <90 mm Hg or >10 mm Hg fall if initial SBP <90 mm Hg). No patients developed both hypoxemia and hypotension.

CONCLUSIONS: Rates of hypoxemia and hypotension during prehospital RSI performed by London HEMS are relatively low. They are less than that found in previous studies of prehospital RSI and are similar to those reported in studies of in-hospital emergency RSI undertaken in the emergency department or ward setting. We therefore conclude that prehospital RSI has an acceptably low complication rate when performed by appropriately trained personnel.