Variations in rapid sequence intubation practices: a survey study from Saudi Arabia

Background: Rapid Sequence Intubation (RSI) is a crucial technique for securing the airway in emergencies. A comprehensive understanding of healthcare professionals' practices and preferences is essential for enhancing patient outcomes. Methods: We conducted a crosssectional, internet-based survey targeting physicians in acute care settings in the Kingdom of Saudi Arabia. This study included emergency and critical care medicine staff members who examined their practices, preferences and perceptions related to RSI. Participants provided information on their preferred induction agents, methods for confirming intubation, post-intubation care, and other aspects pertinent to RSI. Results: The survey received responses from 491 physicians across various institutional settings in Saudi Arabia. Eighty-one percent of participants reported adherence to the conventional RSI approach, while 73.8% correctly identified its purpose in emergency scenarios. Sixty-one percent of respondents defined an "attempt" at RSI as the insertion of the laryngoscope blade into the oropharynx, regardless of endotracheal tube (ET) placement. Propofol was the preferred induction agent for hemodynamically stable patients (38.9%), followed by etomidate (32.2%). Only 19.5% utilized the head- up position during RSI. Apneic oxygenation was practiced by 66.4% of the physicians, with the remainder either unaware of or skeptical about this technique. The most commonly used method for confirming ET tube placement was direct visualization of the tube passing through the vocal cords; however, only 36.2% of physicians employed waveform capnography. Conclusions: This study offers important insights into the current RSI practices and preferences among healthcare professionals. While some practices are consistent with evidence-based guidelines, others do not, emphasizing the need for continued education and updated guidelines. Further research is needed to bridge knowledge gaps and refine RSI practices, thereby improving outcomes in emergency airway management.