Does paramedic rapid sequence intubation always have to be traumatic?

This retrospective review of rapid sequence intubation (RSI) of patients with non-traumatic coma by Mobile Intensive Care Ambulance (MICA) paramedics in Ambulance Victoria, incorporated examination of electronic patient care records for all cases where Suxamethonium was administered between January 2008 and June 2011.

Inclusion criteria were all adult (≥15 years) patients with a Glasgow Coma Score (GCS) ≤9 who underwent RSI for presumed non-traumatic intracranial pathology. Patients undergoing RSI for suspected traumatic brain injury (TBI), drug overdose, coma due to non-neurological causes, return of spontaneous circulation (ROSC) post cardiac arrest, and those transported by air ambulance were excluded from analysis.

A total of 1 152 patients underwent RSI and road transportation during the study period. Cases that were excluded comprised: 263 TBI, 194 drug overdose, 134 post cardiac arrest, and 10 miscellaneous (hypothermia, airway burns, near drowning and suspected liver failure).

In the remaining 551 patients, MICA paramedics achieved an RSI success rate of 97.5% based on a maximum of two attempts at intubation. A total of 360 older (≥60 years) and 191 younger (15–59 years) patients underwent RSI. Mean pre RSI systolic blood pressure (SBP) was significantly higher in older patients (168 versus 153 mmHg, p <0.001). Mean decrease in SBP post RSI was greater in the older rather than the younger patients, although the difference was not statistically significant (20 mmHg versus 16 mmHg, p=0.074).