RAFT 5: SECURE

Why are we doing SECURE?

RSI technique has changed significantly since its original description.
There appear to be many variations of the ‘modified’ RSI and the available guidance reflects this heterogeneity.
Indications for employing an RSI strategy are also evolving and difficult to delineate.
Meanwhile, pulmonary aspiration and other complications from airway management remain an important cause of morbidity and mortality.

The broader why question:

In the Pamela Marking: Prevention of Future Deaths Report. The coroners concerns listed RSI practice as one of the key areas which may have contributed to her death.

Notably the concerns included:

(A) A lack of ‘Updated’ National Guidelines for Rapid Sequence Induction (RSI) of Anaesthesia for emergency surgery

(B) Lack of ‘Updated’ National Guidelines to support the use of TIVA for RSI

(C) Lack of ‘Updated’ Guidelines for use of Cricoid pressure and other measures to protect the airway in a RSI anaesthetic.

SECURE aims to provide important insight into the current UK RSI practice to inform future research, education and guidelines.

Aims:

To characterise in-hospital RSIs in adults across NHS hospitals

Objectives:

Describe the availability of local resources surrounding RSI events
Capture contemporary clinical practice around RSI events performed across all areas of the hospital by cross-speciality intubating teams
Describe and estimate the incidence of immediate complications of RSI events
Evaluate individual practitioners’ perspectives of RSI and self-reported practice using clinical vignettes
Compare resources, self-reported practice and observed practice surrounding RSI events across the NHS and audit the findings against current recommendations

RAFT 5: SECURE is a UK wide, cross-specialty service evaluation of Rapid Sequence Intubation (RSI) events.

Practically SECURE will consist of three stages - a site survey, an activity survey and clinical vignettes.

Key information:

Title: SECURE – Service Evaluation of Cross-Specialty UK Rapid sequence intubation (RSI) Events

Chief investigator: Dr Jonathan Barnes, Consultant Anaesthetist (UHBW)
Sponsor Site: University Hospitals Bristol and Weston NHS Foundation Trust (UHBW) – partnered with Bristol NHS Group

Study Type: Service evaluation - UK-wide, multi-centre, prospective

Study Setting: NHS Trusts in England, Wales, Scotland and Northern Ireland
Study Sites: Single NHS hospitals

Eligibility: NHS hospitals with at least one of the following adult services: emergency medicine, critical care medicine and/or anaesthesia

Data Collection: Anonymised survey data will be collected using online forms and stored

securely in a REDCap database hosted at the Sponsor Site (UHBW)

01-31st March

A survey examining RSI resources, infrastructure and governance.

Covers all acute clinical areas.

What tools do we have at our disposal when conducting RSI?

ACTIVITY SURVEY

13th April - 25th May

An observational study recording RSI practice across anaesthesia, intensive care and emergency medicine at each site.

What is RSI practice today?

CLINICAL VIGNETTE

01-30th June

A survey investigating individual perceptions around RSI practice in the UK.

What are the key drivers of variation in practitioners' decision-making?

About

Key dates

Materials

MATERIALS

Main Protocol

Letter for study sites

Regional Lead
Guide

Site lead

Checklist

Site Survey:
Worked Example

Site Survey
Site Survey Hub (coming soon)

Misc:
Regional network contact list

Promotional Flyer

Secure as a service evaluation

Site lead

Guide

Site Survey:
Site Survey PDF (coming soon)

Interactive Map

How to get involved

HOW TO GET INVOLVED

Recruitment of site leads and collaborators begins in December! Contact your regional lead or resident research network (or TERN if an ED trainee!) and let them know you'll be interested in becoming a site lead or collaborator.

Events