Delayed sequence intubation in prehospital airway management: a narrative review of oxygenation and first pass success

Description

Intubating someone at the roadside is not the job it is in an anaesthetic room. Before the drugs go in, the patient is meant to breathe oxygen through a mask until their lungs are full of it, and that is what buys the crew time once the patient stops breathing on their own. Agitated, hypoxic patients will not tolerate the mask, so the crew often starts with less oxygen on board than they need, with one attempt and no second team down the corridor. Delayed sequence intubation tries to fix this by changing the order. The sedative goes in first, so the patient will tolerate the mask, and the drug that stops them breathing follows only once the oxygen is in. Same drugs, different sequence, and the claim is that a properly preoxygenated patient has longer before their oxygen level falls. Whether that holds outside hospital is not settled, and most of what has been published is small and observational. This project gathers those studies and works out what the technique actually does.

Student responsibilities

Read up on prehospital airway management and why preoxygenation fails in agitated patients. Help run the search, screen studies against the criteria, pull out the oxygen and first-attempt numbers, and write a section of the paper.