Table 3 Procedural steps performed by crews stated in absolute numbers and percentages
STEPS: | Performed n (%) | Not performed n (%) | COMMENT / DESCRIPTION |
|---|---|---|---|
EQUIPMENT | |||
Pulse oximetry | 34 (94) | 2 (6) | Monitoring with pulse oximetry initiated before RSI |
Three-lead ECG | 8 (22) | 28 (78) | Monitoring with three-lead ECG initiated before RSI |
Non-invasive blood pressure (NIBP) | 35 (97) | 1 (3) | Monitoring with NIBP initiated before RSI |
Invasive blood pressure (IBP) | 5 (14) | 31 (86) | Monitoring with IBP initiated before RSI |
Intravenous fluid | 35 (97) | 1 (3) | Establishing intravenous infusion with crystalloid |
Additional intravenous route | 13 (36) | 23 (64) | Placement of extra peripheral venous cannula |
Oxygen present | 32 (89) | 4 (11) | Presence of oxygen tank addresses loudly by one crewmember |
Suction present and tested | 20 (56) | 16 (44) | Presence of suction addressed loudly by one crewmember, and functional testing applied |
Preparation of equipment | 15 (41) | 21 (59) | Complete planning and preparing for additional airway equipment before RSI |
PROCESS RELATED | |||
Optimisation of posture | 24 (67) | 12 (33) | Raising back of ambulance-stretcher when arriving to patient |
Preoxygenation | 35 (97) | 1 (3) | Preoxygenation before conduction of RSI |
Early assisted ventilation | 16 (44) | 20 (56) | Bag-valve-mask ventilation initiated first 2 min |
Fluid bolus | 3 (8) | 33 (92) | Deliberately increasing intravascular volume before RSI |
Vasoactive bolus | 4 (11) | 32 (89) | Deliberately increasing vascular resistance before RSI |
Patient elevated head | 14 (39) | 22 (61) | Establishing the patient in “sniffing position” with an elevated thorax, suitable for RSI of adipose patient. |
Assisted ventilation after failed RSI | 34 (94) | 2 (6) | Provide oxygen to patient by assisted ventilation with bag-mask-valve |
Implementation of plan B | 18 (50) | 18 (50) | Use of supraglottic device after failed RSI |
Doctor placed lateral to patient for RFST | 34 (94) | 2 (6) | Taking position at side of patients’ neck, opposed to standing behind head before RFST |
Active extension of neck | 15 (42) | 21 (58) | Adequate optimization of patient before RFST |
Active build-up under shoulders | 6 (17) | 30 (83) | Adequate optimization of patient before RFST |
Doctor preparing medication | 2 (6) | 34 (94) | When not performed, HCM or pilot is preparing the RSI medications. |
Early capnography | 19 (53) | 17 (47) | Connecting capnography first 10 s after ETT-placement |
Auscultation | 36 (100) | 0 | Bilateral auscultation to confirm ETT-placement |