The Impact of Suctioning on Oxygenation During Rapid Sequence Intubation in the Emergency Department: A Multi-Center Pilot Randomized Controlled Trial.

Background: Recent trends in emergency airway management encourage longer periods of suction, and the use of more powerful suction devices. Whether the intensity of oropharyngeal suction during laryngoscopy causes more rapid desaturation is unknown.

Study objective: This study aimed to determine whether longer duration of suction leads to more significant desaturation in Emergency Department patients undergoing Rapid Sequence Intubation (RSI).

Methods: A multicenter pilot randomized controlled trial was conducted at 3 academic tertiary care level 1 trauma centers. Emergency Department patients undergoing RSI and laryngoscopy were randomized to either as needed suction or constant suction. The primary outcome was the decrease in oxygen saturation from the time the laryngoscope blade entered the mouth until endotracheal tube confirmation.

Results: A total of 76 patients were enrolled (37 in as needed suction, 39 in constant suction). The median absolute drop in saturation was 0% (IQR 0-1) in the as needed suction group and also 0% (IQR 0-0) in the constant group (p = 0.321).

Conclusion: The study found that constant suctioning during Emergency Department laryngoscopy facilitated by RSI does not cause more rapid desaturation compared to as needed suctioning. However, the reliability of these results is limited by the small sample size and convenience sampling which likely skewed the cohort to patients less likely to develop hypoxia. Further studies are needed to confirm these findings and their implications for emergency airway management.