The Impact of Suctioning on Oxygenation During RSI in the Emergency Department

NCT06667336 | Completed

• 1 other identifier: 2020-01-32
• Study Type: interventional
• Target: 76
• Locations: 1 country
• Sites: 1

Brief Summary

Rapid Sequence Intubation (RSI) is a common procedure in Emergency Departments (ED). However, it is a high-risk procedure and has been associated with significant complications including hypoxia, hypotension, airway trauma, aspiration, and death. Specifically, hypoxic episodes during intubation can lead to poor outcomes such as dysrhythmias, haemodynamic compromise, hypoxic brain injury and cardiac arrest, and is therefore of primary concern during any intubation procedure. Aspiration is a serious adverse event and potential cause of hypoxia during RSI and can lead to poor patient outcomes downstream of the procedure. The reported incidence of aspiration during RSI in the ED ranges from 3 to 8% in the ED population. In order to achieve an optimal view of the glottis and prevent pulmonary aspiration of fluids in the oropharynx, providers apply suction prior to and during laryngoscopy, using a Yankauer or large-bore suction catheter. There is currently significant variation in suctioning during laryngoscopy, with some providers using very little suction as needed to clear heavy fluids (judicious suctioning), while others utilise suction aggressively (lead with suction) and as a part of their routine laryngoscopy technique. Evidence suggests inline suction on already-intubated patients accelerates desaturation, but we are aware of no studies examining the impact suctioning has on the speed of desaturation during emergent endotracheal intubation. This pilot study aims to compare the effects of intermittent, as-needed "judicious" suctioning versus aggressive "continuous" (lead with) suctioning on oxygenation during rapid sequence intubation in the emergency department.

Conditions

RSI

Keywords

RSI; Emergency Department; Resuscitation

Outcome Measures

Primary Outcomes (1)

• Oxygen saturation achieved (SpO2)

  the oxygen saturation achieved (SpO2) at the time of tube placement (via confirmation with first ETCO2 waveform) achieved during the intubation period.

  10 minutes

Secondary Outcomes (6)

• Incidence of Desaturation

  2 minutes

• Lowest O2 Saturation

  2 minutes

• End-Tidal Oxygen Concentration ( ETO2)

  2 minutes

• Time from Preoxygenation

  5 minutes

• Complications During RSI

  1 minute

Study Arms (2)

Intermittent Suction

ACTIVE COMPARATOR

This suction was applied only as needed to clear secretions

Procedure: intermittent suction

Continuous Suction

ACTIVE COMPARATOR

The suction catheter was inserted at the start of laryngoscopy and maintained in the oropharynx until the moment of ETT delivery

Procedure: continuous suction

Interventions

intermittent suction PROCEDURE

This suction was applied only as needed to clear secretions

Intermittent Suction

continuous suction PROCEDURE

The suction catheter was inserted at the start of laryngoscopy and maintained in the oropharynx until the moment of ETT delivery.

Continuous Suction

Eligibility Criteria

• Age: 18 Years - 120 Years
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• Emergency Medicine Patients
• Requiring Rapid Sequence Intubation in the Resuscitation Bay
• years+

You may not qualify if:

• Patients that have a heavily soiled airway (i.e. secretions, vomitus, blood)

Sponsors & Collaborators

• Maimonides Medical Center: lead

Study Sites (1)

Maimonides Medical Center

Brooklyn, New York, 11219, United States

Location

MeSH Terms

Conditions

Emergencies

Condition Hierarchy (Ancestors)

Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: October 28, 2024
• First Posted: October 31, 2024
• Study Start: September 1, 2021
• Primary Completion: May 31, 2024
• Study Completion: October 28, 2024
• Last Updated: January 13, 2025

Record last verified: 2025-01

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)