Effectiveness of an Optimization Strategy for Emergency Tracheal Intubation on Postintubation Morbidity: A Cluster Randomized Controlled Trial

What this Trial Is About

This research aims to evaluate in adult patients who require emergency tracheal intubation due to vital distress the effect of a combined strategy designed to reduce complications related to intubation. The study assesses how using rocuronium as a paralytic agent, providing bag face-mask ventilation before intubation, and systematically applying the Gum Elastic Bougie (GEB) at the first intubation attempt may impact intubation-related morbidity. Previous studies showed individual benefits of these approaches, but their combined effect in emergencies has not been assessed. The trial compares two groups: one group receives a combination rapid sequence intubation (RSI) strategy using rocuronium, bag-mask ventilation between induction and laryngoscopy, and systematic GEB use to aid intubation. The other group follows current recommendations using succinylcholine for RSI, no routine bag-mask ventilation before intubation, and GEB use only if intubation fails under direct laryngoscopy. Emergency physicians perform intubations and record outcomes. Participants will be monitored closely during and after intubation. Data collection includes medical history, vital signs such as arterial pressure, oxygen saturation, and heart rate. Researchers will track severe intubation-related complications occurring within the first hour and assess intubation difficulty using various measures on the day of intubation. Outcomes like mortality and use of sedatives or vasopressors are recorded up to 28 days after inclusion. The overall study period extends until September 2026.

Optimisation Strategy for Emergency Tracheal Intubation