RSI in Head Trauma


Keith Wesley, MD, FACEP | | Wednesday, June 27, 2007

Fakhry SM, Scanlon JM, Robinson L, et al: "Prehospital rapid sequence intubation for head trauma: Conditions for a successful program." Journal of Trauma. 60(5):997 1001, 2006.

The Science

A medical helicopter service examined its patient database to determine the ability of "well-trained" paramedics to successfully intubate patients with significant head trauma. Of 1,117 trauma patients, 175 had rapid sequence intubation (RSI) attempted. Seventy percent were intubated on the first attempt, 89 percent by the second attempt, and 96 percent by the third attempt. There were no undetected esophageal intubations. All patients were continuously monitored for oxygen saturation, heart rate and end-tidal CO2, and multiple tube placement conformation methods were utilized. The authors concluded that "prehospital RSI for trauma patients can be safely and effectively performed."

The Street

This paper is clearly written in response to the rising controversy of prehospital RSI. Unfortunately, the authors are not comparing apples to apples. Although they demonstrate that "well-trained" paramedics can successfully intubate a patient after three attempts, they do not provide us with the outcomes of these patients, as have several recent studies that have demonstrated that regardless of the prehospital success rate, the neurological outcome and death rate of these patients is higher than those intubated in the ED. However, this paper does highlight the key components of a proficient prehospital RSI program, which are extensive education and experience of the paramedic in combination with close physiologic monitoring of the patient.

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Related Topics: Patient Care, Airway and Respiratory

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Keith Wesley, MD, FACEP

Keith Wesley, MD, FACEP, is the Minnesota State EMS medical director and the EMS medical director for HealthEast Ambulance in St. Paul, Minn. and and can be reached at


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