Students Research in Progress
Tuesday, November 14, 2023
08:30 AM–10:00 AM
Abstract
Introduction: Rapid-sequence intubation (RSI) involves the administration of an induction agent and neuromuscular blocker (NMB) to facilitate endotracheal intubation. Following RSI, analgosedation targeting light levels of sedation is preferred to optimize clinical outcomes; however, awareness with paralysis (AWP) has been reported following emergency department (ED) RSI and is associated with negative outcomes. Use of long-acting NMB, medication underdosing (induction, analgesics, sedatives), and delays in post-RSI analgesia/sedation initiation extending beyond the duration of action of common induction agents may increase AWP risk. Involvement of emergency medicine pharmacists (EMP) during RSI has been shown to decrease time to post-RSI analgesia/sedation initiation. This project aims to assess the impact of expanding EMP coverage overnight on post-RSI analgesia/sedation.
Research Question or Hypothesis: What is the impact of overnight EMPs on post-RSI analgesia and sedation initiation in the ED?
Study Design: Single-center retrospective cohort study.
Methods: Patients =18 years receiving rocuronium or succinylcholine for ED RSI between 23:00 and 06:30 were identified through an electronic report. Four hundred fifty-eight patients were screened for inclusion and divided into two groups: pre-EMP (5/2021-2/2022) (n=153) and post-EMP (5/2022-2/2023) (n=134). Exclusion criteria include ED length of stay < 30 minutes following RSI, intubation before ED arrival, ED death, cardiac arrest during or before ED stay, incarceration, and pregnancy. Overnight EMP involvement was identified by clinical intervention documentation, EMP medication dispensing from automated dispensing cabinets, or nursing documentation of EMP presence. The primary outcome was time to first dose of post-RSI analgesic or sedative with and without overnight EMP presence. Secondary outcomes were time to first dose of analgesic and sedative and prescribing practices. Data were analyzed using an unpaired student t-test or Mann-Whitney U Test for continuous variables and Chi-square test for categorical variables.
Results: In progress.
Conclusion: In this study, presence of an overnight EMP contributed to more timely initiation of post-RSI sedation and analgesia.
Presenting Author
Sarah Davis PharmD/MHCA Candidate 2025UAB
Authors
Emma Chee-How Pharm.D.
UAB