Survey on the current management of rapid sequence induction in Germany.

Background: The practice of rapid sequence induction (RSI) differs widely within and between countries. We undertook this web-based survey to assess the variability in the practice of RSI amongst German anesthetists. We hypothesized that considerable variability exists.
Methods: In 2009, we electronically asked all anesthetists listed in the corporate e-mail directory of the German professional anesthesia societies to participate in a web-based survey consisting of 26 questions related to various management aspects of RSI.
Results: Of 12180 listed anesthetists, 4259 opened the website (35%). Of those, 2906 answered all questions (website response rate 68.2%; overall 23.9%). The survey revealed considerable differences in the practice of RSI with regard to patient positioning, preoxygenation, use of neuromuscular blocking drugs, handling of nasogastric tube, and application of cricoid pressure. With the exception of cricoid pressure, such differences were unrelated to the anesthetist's qualification, work experience, and type and size of hospital. A majority considered preoxygenation (95%), a stylet inserted in the endotracheal tube (86%), no mask ventilation before intubation (80%), and an additional suctioning device (62%) essential components of a RSI.
Conclusion: This to date largest survey undertaken in the context of RSI documents large management differences in the practice of RSI amongst German anesthetists. These differences are unrelated to qualification, years of work experience and type of institution. This survey emphasizes the need for solid scientific evidence regarding all interventions undertaken in the context of RSI.