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Don’t DSI…Rapid Sequence Airway
Darren Braude, MD Professor of EM, EMS and Anesthesiology
University of New Mexico @darrenbraude
R.S.I.D.S.I.R.S.A.
Concept Evolution
So what is R.S.A.?
Advantages
• Faster –Minimal interruption of ventilation – Get on with diagnostics and therapeutics – Get off scene
• High success rates • Minimal airway trauma
Disadvantages
• Some patients are poor EGD candidates – Upper airway obstruction –Morbid obesity – Severe lung disease
• Necessitates secondary procedure • Does not provide “definitive” airway
“The best is the enemy of the good”
Voltaire a long time ago
“The effort to avoid aspiration that may have already occurred or may never occur often leads to hypoxemic complications or
even death”Braude – Just Now
Our Data
• 55 Prehospital Patients –Many predicted difficult intubations and/or
performed in confined space aircraft • 93% success – Remainder required intubation
• 3/41 (7%) with evidence of aspiration – Lower than our ETI population
How I use RSA• Prehospital – On scene to keep scene times short – In-flight
• In-hospital – Patients with refractory hypoxemia likely
secondary to de-recruitment that are not good candidates for DSI or to facilitate endoscopic intubation via the EGD
American Journal of Respiratory and Critical Care MedicineVolume 175, Number 5 (2007), Page 521
100 miles/160 km
60 miles/100 km
Summary• RSA is an alternative to RSI for selected
situations, particularly for prehospital use and hypoxemic patients that are poor candidates for DSI
• RSA has not been subjected to RCTs
• SMACCDUB has been AWESOME!!
