Emergency Department use of Apneic Oxygenation Versus Usual Care During Rapid Sequence Intubation: A Randomized Controlled Trial (The ENDAO Trial)

Objectives Desaturation leading to hypoxemia may occur during rapid sequence intubation (RSI). Apneic oxygenation (AO) was developed to prevent the occurrence of oxygen desaturation during the apnea period. The purpose of this study was to determine if the application of AO increases the average lowest oxygen saturation during RSI when compared to usual care (UC) in the emergency setting. Methods A randomized controlled trial was conducted at an academic, urban, level 1 trauma center. All patients requiring intubation were included. Exclusion criteria were patients in cardiac or traumatic arrest or if pre-oxygenation was not performed. An observer, blinded to study outcomes and who was not involved in the procedure recorded all times, while all saturations were recorded in real time by monitors on a secured server. Two hundred patients were allocated to receive apneic oxygenation (n=100) or usual care (n=100) by pre-determined randomization in a 1:1 ratio. Results Two-hundred and six patients were enrolled. There was no difference in lowest mean oxygen saturation between the two groups (92, 95% CI 91 to 93 in AO vs. 93, 95% CI 92 to 94 in UC, p=0.11). Conclusion There was no difference in lowest mean oxygen saturation between the two groups. The application of AO during RSI did not prevent desaturation of patients in this study population. This article is protected by copyright. All rights reserved.