Objectives In a video-based study of rapid sequence intubation (RSI) in

Objectives In a video-based study of rapid sequence intubation (RSI) in a pediatric emergency department (PED) 33 of children experienced oxy-hemoglobin desaturation (SpO2< 90%). undergoing RSI over 12 months. Desaturation was more common in patients 24 months of age and younger (59%) than in patients older than 24 months of age (10%). Variables associated with desaturation in patients 24 months of age and younger were duration of attempts (both individual and cumulative) the occurrence of esophageal intubation a respiratory indication for intubation and young age. The receiver operating characteristics curve for the model had an area under the curve of 0.80 (95% CI = 0.67 to 0.92). Forty-six percent of desaturations occurred after 45 seconds of laryngoscopy and 82% after 30 seconds. The odds ratio for desaturation on individual attempts lasting longer than 30 seconds (vs. those 30 seconds or less) was 5.7 (95% CI = 2.26 to 14.36). Conclusions For children 24 months of age or younger undergoing RSI in a PED respiratory indication for intubation esophageal intubation and duration of laryngoscopy (both individual and cumulative) were associated with desaturation; the number of attempts was not. Interventions to limit attempt duration in the youngest children may improve the safety of RSI. INTRODUCTION In a video-based study of rapid sequence intubation (RSI) in a high-volume pediatric emergency department (PED) we found that the process and outcomes of this critical procedure were suboptimal.1 Almost two-thirds of patients had at least one adverse effect during RSI. Oxy-hemoglobin desaturation (SpO2 <90%) occurred for a third of patients half of whom experienced more than one episode. For patients with available data one third experienced SpO2 ≤60%. Our findings suggested that desaturation during RSI for children may be more common than previously reported.2 Improving ZC3H13 the performance and safety of RSI requires understanding patient process and provider characteristics associated with desaturation and other adverse effects. Several studies have reported analyses of adverse CTP354 effects during emergency intubation 3 but each has significant limitations. First most used a composite outcome of “adverse effect ” grouping outcomes such as esophageal intubation dental injury and desaturation which do not likely share a causal pathway.3 4 6 Second nearly all used data collected by self-report or chart review.3-8 In our experience these type of data are often incomplete in comparison with video review and are inadequate to calculate accurate time intervals. Third to our knowledge no study of the adverse effects during intubation of ED patients has included time-based variables such as the duration of RSI or laryngoscopy attempts. RSI is the method by which the majority of patients in prehospital emergency and critical care settings are intubated.8 10 11 In a PED patients undergoing RSI are typically at the younger end of the pediatric age spectrum critically ill or injured and have acute and/or chronic cardiorespiratory illnesses. Prevention of secondary injury is usually of particular importance for these vulnerable patients. Hypoxia is a recognized cause of secondary injury during resuscitation 12 13 and can be the harbinger of more profound physiologic deterioration including pulseless arrest.14 Our original findings suggest a need for further study and analyses of the characteristics associated with desaturation during RSI. Analyses CTP354 based on data CTP354 collected by video observation allow for the inclusion of time-based variables and could be used both to inform targeted improvement efforts and to provide a firmer evidence base for current recommendations for standard RSI intervals.15 The goal of the current study was to identify patient and RSI process characteristics including time-based variables associated with desaturation during RSI. METHODS Study Design This was a planned analysis of data collected during a previous study which used video review as the primary method of data collection. Our protocol was approved by our institutional review board prior to study commencement. Study Setting and Populace The study setting was CTP354 the resuscitation area of an academic high-volume PED that.