Emergency Nurse Practitioner’s Role in Supporting Safe Rapid Sequence Intubation in the Emergency Room

Abstract

Rapid Sequence Intubation (RSI) is a critical life-saving procedure in patients with respiratory failure, aiming to increase the first-attempt success rate of endotracheal intubation while minimizing associated complications. In emergency settings, particularly within hospital emergency rooms (ERs), the role of the Emergency Nurse Practitioner (ENP), a professional nurse trained in advanced emergency care, has become increasingly essential across all phases of Rapid Sequence Intubation (RSI). ENPs are responsible for airway risk assessment using LEMON and HEAVEN criteria, systematic preparation of medications and equipment based on the SOAP-ME approach, and ensuring safe preoxygenation. They also play a pivotal role in interprofessional communication and coordination. During RSI, ENPs oversee the preparation and verification of sedative agents and rapid-onset neuromuscular blocking agents, patient positioning, continuous monitoring of vital signs, and readiness with backup plans such as supraglottic airways or failed intubation protocols. Following intubation, ENPs assist in confirming tube placement via capnography and closely monitor for complications such as pneumothorax or tube obstruction. These responsibilities reflect the ENP's operational leadership in high-risk emergency procedures and highlight the professional nursing potential to support complex interventions within defined scopes of practice. This article proposes strategies to enhance ENP competency and effectiveness in RSI, including the development of clinical practice guidelines (CPG), specialized training curricula, and the establishment of RSI competency certification systems aligned with both national and international standards.