Desaturation leading to hypoxemia during RSI is a familiar picture and apneic oxygenation was developed to prevent occurrence of oxygen desaturation during apneic period. Does the latest evidence support this practice?
ENDAO trial published in Acad Emerg Med is an RCT (first one!) conducted at an academic ED in NYC. 100 patients were randomized to no supplemental oxygen during laryngoscopy and 100 were randomized to apneic oxygenation with flush flow rates >=15LPM.
Results/conclusion: No difference in lowest mean oxygen saturation between the two groups and application of apneic oxygenation during RSI did not prevent desaturation of patients in this population.
What do we take away from this?
- Patients who receive proper pre-oxygenation (3 min with flush 100% O2), apneic oxygenation may not be necessary
- But apneic oxygenation is not expensive, not harmful, and they excluded patients who were unable to receive a full 3 minutes of pre-oxygenation from this study (? crashing patients) so maybe these patients would benefit?
- DON’T DELAY YOUR INTUBATION FOR APNEIC OXYGENATION AS IT MAY NOT HAVE ANY BENEFIT BUT IF YOU HAVE THE TIME AND RESOURCES….WHY NOT?
Caputo N et al. Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (the ENDAO Trial). Acad Emerg Med 2017.