Rapid Sequence Induction Practices In The United States And The United Kingdom: A Comparative Survey Study.

Abstract

Purpose: We aimed to survey the members of anesthesia departments in two large university hospitals, University of Washington (Seattle, USA) (UW-US) and University of Nottingham (Nottingham, UK) (UN-UK) to compare differences in their current approach to rapid sequence induction (RSI). Methods: The survey was distributed in electronic and paper format in 2009. Overall response rate was 48.6% (146/300). Participants were asked to indicate their practice for a RSI technique for emergency appendectomy in a previously healthy adult. Data were summarized descriptively using frequency distribution. Chi square statistic was used to compare frequency of responses. Results: There were several differences in the practice of RSI: 1. Aspiration prophylaxis was preferred in UW-US (40%) versus UN-UK (12%); 2. Preferred patient position was with a head support in UW-US versus 30 head of the bed elevation in UN-UK; 3. UWUS reported not to use mask ventilation prior to intubation (55%) versus UN-UK (78%); 4. The preferred opioid was fentanyl (93%) for UW-US and alfentanil (74%) for UN-UK; 5. Adjuvant drugs were used by 68% of UW-US versus 8% of UN-UK providers; 6. Commonly used induction agents were propofol in UW-US (94%) and thiopental in UN-UK (51%). Both centers preferred succinylcholine for muscle relaxation to rocuronium (UW-US 80% versus UN-UK 90%). Conclusions: RSI practice differed significantly across continents. Due to disagreement and a lack of scientific evidence regarding the standards of RSI, it appears that traditional RSI practice has already been abolished. Revised evidence based guidance statement is due and has the potential to reduce practice variability.