Rapid sequence induction of anaesthesia in elderly patients in the emergency department

• Published in: Resuscitation Vol. 82; no. 7; pp. 881 - 885
• Main Authors: Theodosiou, Catherine A, Loeffler, Ruth E, Oglesby, Angela J, McKeown, Dermot W, Ray, David C
• Format: Journal Article
• Language: English
• Published: Shannon Elsevier Ireland Ltd 01-07-2011; Elsevier
• Subjects: Age Factors; Aged; Aged, 80 and over; Anaesthesia; Anesthesia - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Critical Illness - mortality; Critical Illness - therapy; Emergency; Emergency and intensive care: techniques, logistics; Emergency Service, Hospital; Emergency treatment; Emergency Treatment - methods; Female; Hospital Mortality - trends; Humans; Intensive care medicine; Intensive care unit. Emergency transport systems. Emergency, hospital ward; Intubation, Intratracheal - methods; Male; Medical sciences; Outcome; Prognosis; Retrospective Studies; Risk Factors; Scotland - epidemiology; Tracheal intubation; Scotland; Anaesthesia; Emergency treatment; Aged; Outcome; Tracheal intubation; Human; Intensive care; Prognosis; Emergency department; Treatment; Intubation; Emergency; Elderly; Resuscitation
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2011.02.025

Abstract Aim Our primary objective was to evaluate the characteristics and outcomes of elderly (≥80 years) patients undergoing rapid sequence induction of anaesthesia and intubation (RSI) in our emergency department (ED). Methods We retrospectively analysed data collected prospectively between January 1999 and December 2007. We retrieved age; gender; presenting diagnosis; indication and urgency for RSI; complications related to RSI; hospital destination; and outcome. Results 1686 patients underwent RSI in the ED during the study period; 107 (6%) were aged ≥80 years. The mean age (range) was 84 (80–91) years. 94 patients (88%) were living in a private residence before presentation to the ED. Intracerebral haemorrhage, ischaemic stroke and head injury were the commonest presenting diagnoses. Forty-one patients were admitted to intensive care, 55 were admitted to a ward (31 for palliative care) and 11 died in the ED. Seventy-two patients (67%) died; of the 35 survivors, 21 (60%) made a good recovery with no requirement for increased social care. Outcome was worse after neurological diagnoses, sepsis and trauma than after cardiac or respiratory failure, seizures or drug overdose. Presenting diagnosis predicted outcome on univariable analysis ( p < 0.001), but it was not possible to calculate risk for individual diagnoses. RSI-related complications, of which hypotension was commonest, occurred in 15% of patients. Conclusion A small number of patients who undergo RSI in our ED are aged ≥80 years. They generally have high mortality with only 20% surviving to hospital discharge with no increase in dependency; however 60% of survivors make a good recovery. In this highly selected elderly population age is not the main determinant of outcome which is influenced more by presenting diagnosis.