Comparison of rapid sequence intubation (RSI) and non-RSI in the emergency room at Maechan Hospital
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Abstract
BACKGROUND: Rapid sequence intubation (RSI), which utilizes an induction agent combined with a paralytic agent, has become widely used. Studies have shown that the first-attempt success rate is high and that complications are reduced.
OBJECTIVE: To compare the first-attempt success rate, the endotracheal intubation time and complications between RSI and non-RSI.
METHODS: This efficacy research was a prospective observational study conducted in 84 patients who required endotracheal intubation in the emergency room at Maechan Hospital. Patients were equally divided into two groups: 42 received RSI, and 42 did not receive a neuromuscular blocking agent (non-RSI). Demographic characteristics, intubation techniques, number of intubation attempts, time from mouth opening to successful intubation, and intubation-related complications were recorded. Data were analyzed using Fisher’s exact test, the Student’s t-test, the Wilcoxon rank-sum test, multivariable logistic regression, and multiple linear regression.
RESULTS: Compared with the non-RSI group, patients receiving RSI had a higher first-attempt success rate; however, the difference was not statistically significant (100% vs. 88.1%, p=0.055). Multivariable logistic regression analysis showed that RSI was associated with an 11.9-fold increase in first-attempt success; however, this was not statistically significant (95% CI: 0.7–219.6, p=0.095). The time to successful endotracheal intubation was significantly shorter in the RSI group (10 seconds [IQR 8–11.8] vs. 19 seconds [IQR 12–35.8], p<0.001). Multiple linear regression analysis demonstrated that RSI was associated with a 18.9-second shorter intubation time (95% CI: −30.6 to −7.4, p=0.002). The incidence of complications was significantly lower in the RSI group (16.7% vs. 42.9%, p=0.016).
CONCLUSIONS AND RECOMMENDATIONS: Although no statistically significant difference in first-attempt success rates was found between the two groups, RSI significantly reduced intubation time and the incidence of complications. Therefore, RSI should be considered a standard practice for endotracheal intubation in the emergency room.
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