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High-Flow Nasal Cannula versus Bag Valve Mask for Preoxygenation during Rapid Sequence Intubation in the Emergency Department: A Single-Center, Prospective, Randomized Controlled Trial

Published online by Cambridge University Press:  18 December 2023

Muhammed Fatih Cırıl Open the ORCID record for Muhammed Fatih Cırıl [Opens in a new window] ,
Mustafa Akarca ,
Ebru Unal Akoglu ,
Tuba Cimilli Ozturk  and
Özge Onur
Muhammed Fatih Cırıl*
Affiliation:
Sancaktepe Sehit Prof Ilhan Varank Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
Mustafa Akarca
Affiliation:
Tokat Erbaa State Hospital Emergency Department, Tokat, Turkey
Ebru Unal Akoglu
Affiliation:
Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
Tuba Cimilli Ozturk
Affiliation:
Fatih Sultan Mehmet Education and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
Özge Onur
Affiliation:
Marmara University School of Medicine, Istanbul, Turkey
*
Correspondence: Muhammed Fatih Cırıl, MD Specialist of Emergency Medicine Sancaktepe Sehit Prof Ilhan Varank Education and Research Hospital Department of Emergency Medicine Istanbul, Turkey 34785 E-mail: fthcrl@gmail.com
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Abstract

Objective:

Hypoxia is a frequently reported complication during the intubation procedure in the emergency department (ED) and may cause bad outcomes. Therefore, oxygenation plays an important role in emergency airway management. The efficacy of oxygenation with high-flow nasal cannula (HFNC) in the ED has been studied, though the evidence is limited. The study aim was to compare two methods of preoxygenation in patients undergoing rapid sequence intubation (RSI) in the ED: (1) HFNC and (2) bag-valve mask (BVM) oxygenation.

Methods:

This is a single-center, prospective, randomized controlled trial (RCT) in adult ED patients requiring RSI. Patients were randomized to receive preoxygenation with either HFNC or BVM. While HFNC therapy was continued during the intubation procedure, BVM oxygenation was interrupted for laryngoscopy. The primary outcome was the lowest peripheral oxygen saturation (SpO2) level during intubation. Secondary outcomes were incidence of desaturation (SpO2<90%) and severe hypoxemia (SpO2<80%) throughout the procedure, intubation time, rate of failed intubation, and 30-day survival rates.

Results:

A total of 135 patients were randomized into two groups (HFNC n = 68; BVM n = 67). The median lowest SpO2 value measured during intubation was 96% (88.8%-99.0%) in the HFNC group and 92% (86.0%-97.5%) in the BVM group (P = .161). During the intubation procedure, severe hypoxemia occurred in 13.2% (n = 9) of patients in the HFNC group and 8.9% (n = 6) in the BVM group, while mild hypoxemia was observed in 35.8% (n = 24) of the BVM group and 26.5% (n = 18) of the HFNC group. However, there was no statistically significant difference between the groups in terms of hypoxemia development (P = .429 and P = .241, respectively). No significant difference was reported in the rate of failed intubation between the groups. Thirty-day mortality was observed in 73.1% of the BVM group and 57.4% of the HFNC group, with a borderline statistically significant difference (difference 15.7; 95% CI of the difference: −0.4 to 30.7; P = .054).

Conclusion:

The use of HFNC for preoxygenation, when compared to standard care with BVM oxygenation, did not improve the lowest SpO2 levels during intubation. Also, the use of HFNC during intubation did not provide benefits in reducing the incidence of severe hypoxemia. However, the 30-day survival rates were slightly better in the HFNC group compared to the BVM group.

Keywords

BVMHFNOpreoxygenationrapid sequence intubation
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 39 , Issue 1 , February 2024 , pp. 45 - 51
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of World Association for Disaster and Emergency Medicine

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