A survey of rapid sequence intubation at the accident and emergency department,Kenyatta National Hospital

Abstract

Background: Rapid sequence intubation is the cornerstone of emergency airway management. This study was carried out at the accident and emergency department of Kenyatta national Hospital. Airway management here is primarily the responsibility of the anaesthesia department. There are no fully fledged emergency physicians practising at this hospital. Objective: To evaluate the practice of rapid sequence intubation at the accident and emergency department. Methods: This was a prospective, descriptive analytical study of endotracheal intubations carried out at the accident and emergency department. The study population included patients undergoing rapid sequence intubation. Data was collected in real time using a survey tool. Data collected included demographic data of the patients; indications for rapid sequence intubation; timing aspect; the practitioner characteristics; equipment, preparation, and execution of rapid sequence intubation. Results: Data from 186 rapid sequence intubations were collected and recorded. 92% were adult patients. 75.8% of the patients were male. Severe head injury was the leading cause of rapid sequence indication (69.3%). In 61.8% of cases, the decision to undertake rapid sequence intubation was made after triage but before detailed medical evaluation. Most of the anaesthetic practitioners arrived after 10 minutes of being contacted. Most of the non-anaesthetic practitioners arrived within 5 minutes of being contacted. Only in 15.1% of intubations were adjuncts to difficult airway available. Cricoid pressure was correctly applied in 12.4% of intubation. Success of intubation at first attempt was 91.4% and 98.9% after 2 attempts. 20% of the intubations had complications. Conclusion: Rapid sequence intubation is fairly well executed at accident and emergency department of Kenyatta National Hospital.