Methodology: 3/5
Usefulness: 3/5

Bandyopadhyay A, et al. Anesth Analg. 2023 May 1;136(5):913-919.

Question and Methods: This is the first RCT looking at DSI vs RSI in adult trauma patients with no difficult airway features. All intubations performed by an anesthesia PGY2 with direct laryngoscopy.
Findings: The primary outcome was incidence of peri-intubation hypoxia. They report significantly lower rates for DSI (8%) versus RSI (35%, P = 0.001). No difference found in secondary outcomes of first pass success.
Limitations: Primarily limited due to unblinded intubator and medication administering anesthesiologists. Many patients were excluded for difficult airway characteristics, use of video laryngoscopy, and non-anesthesia performed intubations.

Interpretation: This limited study with high selection bias is difficult to generalize to the practice of emergency medicine. Given the lack of high-quality evidence of DSI, RSI continues to remain standard of care.

Dr. Isabella Menchetti

Dr. Christian Vaillancourt




  • Isabella Menchetti

    Dr. Isabella Menchetti is a FRCPC Emergency Medicine resident at the University of Ottawa.

  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, associate professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.

  • Christian Vaillancourt

    Senior Scientist, Clinical Epidemiology Program Ottawa Hospital Research Institute Full Professor, Emergency Medicine University of Ottawa Research Chair in Emergency Cardiac Resuscitation, Emergency Medicine University of Ottawa Associate Medical Director, Regional Paramedic Program for Eastern Ontario Research Interests: Dr. Vaillancourt's current research program focuses on pre-hospital care, specifically improving care and survival for cardiac arrest and trauma victims.