Rapid Sequence Intubation: First-Pass Success Rates
- Rapid sequence intubation, or RSI, substantially increases teh likelihood of successful first-attempt intubation in emergency situations outside of a hospital setting, according to a recent U.S.
- The study, which examined data from the 2022 Emergency Services Organization Data Collaborative, included 12,713 patients.
- However, the odds of achieving success on the first try were notably higher with RSI.
New research confirms rapid sequence intubation (RSI) significantly boosts first-attempt success rates in prehospital settings. This study, analyzing over 12,000 intubations outside of hospital care, reveals that combining a sedative and paralytic during RSI dramatically improves airway management, offering a key advantage. The research highlights a 2.23 increase in success compared to intubation without medication, underlining RSI’s critical role in emergency medicine. Data analyzed from the 2022 Emergency Services Association data Collaborative provides vital insights into the efficacy of different intubation techniques. For more details, visit News Directory 3. Discover what’s next in emergency airway protocols.
Rapid Sequence Intubation Improves Emergency Airway Management
Updated June 29, 2025
Rapid sequence intubation, or RSI, substantially increases teh likelihood of successful first-attempt intubation in emergency situations outside of a hospital setting, according to a recent U.S. study. The research, focusing on patients who needed prehospital intubation but were not in cardiac arrest, highlights the benefits of using both a sedative and a paralytic during the procedure.
The study, which examined data from the 2022 Emergency Services Organization Data Collaborative, included 12,713 patients. The median age was 60, with men comprising 58.4% of the participants. Roughly a quarter of the cases involved trauma. Researchers analyzed various drug-assisted airway management techniques, categorizing them by the medications given before the initial intubation attempt. Thes categories included RSI, sedative-only intubation, paralytic-only intubation, and intubation without medication.
the first-pass success rate stood at 75.1%. However, the odds of achieving success on the first try were notably higher with RSI. The adjusted odds ratio showed a 2.23 increase compared to intubation without medication. Paralytic-only intubation also showed a important boost, with an adjusted odds ratio of 2.11. Sedative-only intubation, on the other hand, showed similar success rates to those achieved without any medication.
Jeffrey L.Jarvis, MD, MS, EMT-P, of the Burnett College of Medicine at Texas Christian University in Fort Worth, Texas, led the study. It appeared online June 4 in the journal Annals of Emergency Medicine.
“in this analysis of a large national EMS dataset of noncardiac arrest patients undergoing endotracheal intubation, rapid sequence intubation was associated with twofold higher odds of first-pass success compared with sedation-only or no-medication approaches,” the authors wrote.
The study acknowledges several limitations. It primarily focused on the association between drug combinations and first-pass success, without assessing causation, the appropriateness of the procedure’s indication, adverse events, or overall clinical outcomes. The researchers also noted variations in EMS treatment protocols across different agencies and a lack of data on clinician experiance with intubation. Potential data entry errors and a small sample size for paralytic-only intubations were also cited as limitations.
What’s next
future research could examine the impact of standardized EMS protocols and clinician training on intubation success rates, and also explore the long-term clinical outcomes associated with different intubation techniques.