2. Emergency inductions in ICU and ED
are risky:
Sicker patients
Difficult airways
Less time for preparation
Pressure to intervene
Human factors
Less familiar environment & equipment
Junior staff out of hours
3.
4. Poor or incomplete planning
Inadequate provision of skilled staff and equipment
Lack of capnography
5.
6.
7. Emergency Induction checklist
Capnography for all intubations
Discussion of difficult intubation plans
8.
9.
10. Simulation – patient needing intubating
Patient showing signs of sepsis and pneumonia
Hypoxaemic and hypotensive
Reduced level of conciousness
Candidates asked to prepare for RSI
1st time as normal
2nd time using checklist
Primary outcome = difference in score
Secondary outcome = time taken to prepare
11. Optimise position
Connect oxygen and preoxygenate
Request new bag of fluids
Request vasopressor
Capnography
Suction
Guedel airway
LMA
Bougie
Propofol infusion (or alternative)
Discussion of plan in case of failed intubation
12. 18 anaesthetists recruited
7 consultants
3 SAS grade
8 trainees (CT2 and above)
Median Score (IQR) Mean Time (secs)
Without checklist 6 / 11 (4 to 7.25) 336.3
With checklist 10 / 11 (8 to 11) 378.2
P value 0.001* 0.097**
*Wilcoxon signed rank test score 150.5
**paired t-test
13. The checklist significantly reduced errors in
preparation for induction
This appeared to be regardless of experience
There was not a significant difference in time
taken
With practice time taken may even be
reduced
14. No. You think you do.
Chances are we all forget 1 or 2 things on the
list.
We want everyone to use it – regardless of
grade and experience.
15. No – there will be no paper copies
It is not a box ticking exercise
It is not a box ticking exercise
▪ It is not a box ticking exercise
It is to be read out loud by the team leader
during pre-oxygenation.
All team members must participate.
Record in the notes that it was done.
16. Yes
it will reduce errors in preparing for RSI’s
We have tested this.
In a simulated RSI
▪ Median without checklist 6/11 (IQR 4 to 7.25), median
with checklist 10/11 (IQR 8 to 11). Wilcoxon signed rank
test score was 150.5, (P=0.001).
17. It is unlikely to significantly prolong
preparation
When done well it may reduce preparation
time
It may also reduce stress
It helps everyone work better as a team
It will reduce the risk of errors
It is time well spent
18. All emergency inductions outside of theatre /
anaesthetic room.
ED, ICU, HDU, Recovery
? On the wards
Not in cardiac arrest situation.
ie whenever drugs are given for induction
outside of theatres
19. Much of intensive care is costly and based on
limited evidence. A checklist is free.
Success on ICU is rarely based on one
intervention, but rather 100’s of interventions
that must all go right…
Can a simple checklist help to make sure that
intubation goes right?
20. With thanks to:
Einir & Adam; Simulation co-
ordinators, Ysbyty Gwynedd, Bangor
Ami, Farbod, Ifan, Eirian, Suzanne for acting
in the training video