Ricard-Hibon A, Chollet C, Leroy C, Marty J
Beaujon University Hospital, Department of Anaesthesiology and Intensive Care, Clichy, France.
Eur J Anaesthesiol. 2002 May;19(5):361-7. doi: 10.1017/s0265021502000583.
The study aimed to evaluate and improve airway management in the prehospital setting, i.e. physicians working on board ambulances. A quality control programme focusing on anaesthesia was instituted to improve the time taken to perform endotracheal intubation.
All consecutive patients requiring tracheal intubation were prospectively analysed before (first period) and after the training programme focusing on anaesthetic protocols for tracheal intubation (second period). The number of attempts at laryngoscopy, the time taken to achieve tracheal intubation, the difficulties encountered and the related complications of the anaesthetic technique were recorded. At the end of the first period, the results were reported to the whole staff of the unit and the anaesthesia protocols were then modified by introducing succinylcholine into the induction sequence, as part of a training programme.
Two-hundred-and-eighty patients were evaluated (97 in the first period, 183 in the second). All patients were successfully intubated in both periods. The percentage of difficult intubations (as assessed by the physician) was lower in the second period (20 versus 35%, respectively; P < 0.01). The success rate at the first attempt was significantly higher (74% [68-80] 95% CI versus 55% [45-65] 95% CI, P < 0.01) and the duration of intubation was significantly shorter in the second period than in the first (1.4 +/- 3.2 vs. 4.1 +/- 6.7 min, respectively; P < 0.001). The incidence of complications (hypoxaemia, laryngospasm, bronchospasm) was lower in the second period (15 versus 31%, P < 0.01).
The time to perform tracheal intubation can be improved by the introduction of succinylcholine into the prehospital anaesthetic protocol. Rapid sequence induction should be taught as a way of improving tracheal intubation in the prehospital setting.
本研究旨在评估并改善院前环境下的气道管理，即救护车上医生的气道管理。实施了一项以麻醉为重点的质量控制计划，以缩短气管插管所需时间。
对所有连续需要气管插管的患者在专注于气管插管麻醉方案的培训计划实施前（第一阶段）和实施后（第二阶段）进行前瞻性分析。记录喉镜检查的尝试次数、实现气管插管所需时间、遇到的困难以及麻醉技术的相关并发症。在第一阶段结束时，将结果报告给该科室全体工作人员，然后作为培训计划的一部分，通过在诱导程序中引入琥珀酰胆碱来修改麻醉方案。
共评估了280例患者（第一阶段97例，第二阶段183例）。两个阶段所有患者均成功插管。第二阶段困难插管的比例（由医生评估）较低（分别为20%对35%；P<0.01）。首次尝试的成功率显著更高（74%[68 - 80]95%CI对55%[45 - 65]95%CI，P<0.01），且第二阶段插管持续时间明显短于第一阶段（分别为1.4±3.2分钟对4.1±6.7分钟；P<0.001）。第二阶段并发症（低氧血症、喉痉挛、支气管痉挛）的发生率较低（15%对31%，P<0.01）。
通过在院前麻醉方案中引入琥珀酰胆碱可缩短气管插管时间。应教授快速顺序诱导作为改善院前气管插管的一种方法。
