P2B060: Integration of Rapid Sequence Intubation Process During Medical and Trauma Resuscitations to Increase Success Rates. a Quality Improvement Study

Purpose/Objectives: Rapid sequence intubation (RSI) is one of the most critical procedures during resuscitation in the emergency department with potential for high-risk complications. Treating RSI as an isolated process during resuscitation can result in unwanted outcomes such as cardiovascular collapse/ arrest. We tested and implemented an intubation check list that integrated cardiovascular resuscitation in “non-crash” intubations to increase the proficiency and safety of intubations using the quality improvement methodology for both pediatric emergency department (PED) and transport services.

Design/Methods: A pilot study was conducted in PED of a tertiary care facility using quality improvement approach prior to full implementation. The goal was to standardize the RSI with specific attention to potential causes of complications, such as cardiac arrest/ bradycardia, failed intubations, hypoxemia, and less optimal medication choices. We aimed to achieve successful intubation within two attempts. The process was then extended to transport services who often intubate pediatric patients prior to transport from referring facilities with no pediatric experience. Outcome, barriers, and complications were analyzed.

Results: The study was started on May of 2022 with preplanning, educations, and process assessment. A total of 40 patients were included in this study including the pilot phase. The process was fully implemented in October 2022. This was followed by expansion to transport services (figure 1). We sustained > 75% compliance with the checklist (Completing the algorithm and documentations). Successful intubation within two attempts were sustained in all patients with exception of one patient who was determined to be a special cause variation (Figure 2). Oxygen saturations were maintained at > 90 % with few exceptions.

Conclusion/Discussion: Standardization of RSI process significantly improved safe and successful intubations within two attempts for patients with acute emergencies excluding crash- intubations in PED and transport services. Further analyses and expansions are ongoing.