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
