A Prehospital Apneic Oxygenation Protocol Correlates with Fewer Desaturations
Daniel J. Pallin, MD, MPH
But reasons why are not clear from this study.
Prior small studies have demonstrated that paralyzed patients desaturate less rapidly when high –flow oxygen is provided via a nasal cannula, which supports the concept that oxygen passively circulates through the glottis and into the alveoli. A paramedic system in Australia instituted such an apneic oxygenation protocol, and investigators retrospectively compared the frequency of desaturation (defined as oxygen saturation <93%) before and after.
During the baseline period, in which apneic oxygenation was used at provider discretion, 22.6% of 310 patients desaturated. During the intervention period, in which apneic oxygenation was required by protocol but compliance was not monitored, 16.5% of 418 patients desaturated.
This retrospective study as not designed in a way that permits us to consider it supportive of prior investigations, because without randomization and compliance monitoring, we cannot be sure what made a difference. This study should not change current practice.
Wimalasena Y et al. Apneic oxygenation was associated with decreased desaturation rates during rapid sequence intubation by an Australian helicopter emergency medicine service. Ann Emerg Med 2014 Dec 20; [e-pub ahead of print].
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