By now we’re all pretty used to employing apneic oxygenation for RSI in the ED. However, most of the data comes from the OR and elective setting or is retrospective.
A recent randomized trial of apneic oxygenation in ICU patients actually failed to show benefit, though this population may have already been maximally preoxygenated and too sick to benefit from apneic oxygenation.
Sackles et al just published the results of their prospective data collection on apneic oxygenation in ED intubations by EM residents in Academic Emergency Medicine.
They found a 13.1% increase (CI 6.2% to 19.9%, OR 2.2 CI 1.5 to 3.3) in first pass success without hypoxemia when apneic oxygenation was used.
Other factors associated with first pass success without hypoxemia were a normal baseline SpO2 (OR 4.8, CI 2.2 to 10.3), used of video laryngoscopy (OR 2.7, CI 1.6 to 4.6), and intubation performed by a senior resident (OR 2.1, CI 1.1 to 3.7).
There are certainly many limitations to this study as it was prospective, non-randomized, and self-reported by the residents. Apneic oxygenation was not required but was its use was encouraged in every intubation. It may be that those who chose to use it were more likely to be successful in the first place.
In any case, apneic oxygenation was independently associated with an increased chance of first pass success without hypoxemia. This study bolsters the evidence for this fast, cheap, easy, low-risk, high-reward intervention for emergency department airway management.