High-Flow Nasal Cannula Therapy for Apneic Oxygenation during Rapid Sequence Induction in the Emergency Department: A Systematic Review.

BACKGROUND

Rapid sequence induction (RSI) is a critical procedure in the emergency department (ED). The use of high-flow nasal cannula (HFNC) oxygen therapy has emerged as a means of pre- and apneic oxygenation during RSI. Considering the unique environment of the ED, it is essential to understand whether there is a clinical benefit to using HFNC during RSI in the ED to guide clinical practice.

OBJECTIVES

This systematic review aims to evaluate the efficacy of HFNC as an oxygenation therapy during the apneic phase of RSI in the ED compared with existing preoxygenation therapies.

METHODS

A comprehensive literature search was conducted across five databases on October 13, 2025 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Four studies (500 patients) met the inclusion criteria. Two of the four studies reported increased safe apnea duration with HFNC (p = 0.006 and p = 0.104). However, there were no observed changes in clinical outcomes, such as mortality rates and the number of desaturation events.

CONCLUSION

HFNC may be considered as an oxygenation strategy during the apneic period of RSI in the ED, although evidence for a clinically meaningful benefit remains limited.