(913) Survey of Critical Care and Emergency Medicine Pharmacists on Post-RSI Analgosedation Practices

Introduction: Post-rapid sequence intubation (RSI) analgosedation (AS) strategies should complement the pharmacokinetic profile of the medications used during RSI. However, there is a paucity of literature describing the optimal post-RSI AS strategy. As such, guidelines do not offer recommendations for how to protocolize post-RSI AS, likely leading to variable post-RSI AS practices among providers and institutions. This study aimed to characterize emergency medicine pharmacists’ (EMP) and critical care pharmacists’ (CCP) perceptions of post-RSI AS practices across the United States.

Methods: An 18-question survey was distributed to CCP and EMP via the ACCP Critical Care and Emergency Medicine PRN listservs between Jan and Feb 2024. It evaluated respondent and practice site demographics and participants selected approaches to post-RSI AS that they both observe and recommend when either a short-acting or long-acting paralytic is utilized during RSI. Descriptive statistics were used to compare EMP and CCP preferences and to characterize trends in post-RSI AS practices.

Results: The survey was distributed to 2551 individuals with 150 (5.9%) completing the survey and included in data analysis. The respondents’ practice areas were evenly split between emergency medicine and critical care (53% vs 47%). Most respondents practiced at community teaching hospitals (41%), academic medical centers (33%), and community non-teaching hospitals (24%). Variability existed between the EMP and CCP approach to post-RSI AS when a short-acting paralytic is used, while both preferred to administer an analgesia and sedative continuous infusion (CI) concomitantly (49% and 50%) when a long-acting paralytic is used. Both EMP and CCP perceive their providers to prefer to first use a sedative CI when a short-acting paralytic is used (45% and 48%) and equally prefer to first use a sedative CI (50% and 44%) or an analgesia and sedative CI concomitantly (39% and 40%) when a long-acting paralytic is used. Most hospitals do not have institutional guidance documents addressing AS management post-RSI.

Conclusions: This study identified variability in EMP, CCP, and perceived provider preferences surrounding post-RSI AS management strategies. Additional research is needed to define the most optimal post-RSI AS approach.