Wang Henry E, Kupas Douglas F, Paris Paul M, Bates Robyn R, Yealy Donald M
Department of Emergency Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 400, Pittsburgh, PA 15213, USA.
Resuscitation. 2003 Jul;58(1):49-58. doi: 10.1016/s0300-9572(03)00058-3.
Previous out-of-hospital airway management data are limited by small, single-site designs. We sought to evaluate the feasibility of performing a prospective, multi-centered evaluation of out-of-hospital endotracheal intubation (ETI) using a standardized data collection tool.
We designed a prospective multi-centered observational study involving 45 advanced life support (ALS) services from a mid-Atlantic state. Using a standardized data form, prehospital personnel reported details of each attempted ETI, including patient demographics, methods used, difficulties encountered, and initial patient outcomes. We calculated and assessed data form return rates (using independent queries of the number of ETI attempted by each EMS service) and missing data entry rates. We also performed preliminary cross-sectional assessments of factors of current interest in out-of-hospital ETI. Accuracy and validity of responses were not evaluated. Data were stored centrally and analyzed using descriptive techniques.
Participants included 8 urban, 15 suburban, 20 rural, and 2 air medical services. Data forms were received on 783 adults receiving ETI attempts during the study period June 1, 2001-November 30, 2001. The pooled data form return rate was 72.7%. Per-service return rates ranged from 0 to 100% and the median per-service return rate was 75%. Non-response (data form not returned for attempted intubation) was problematic, with nine services demonstrating data return rates less than 50%. Data return rates could not be calculated for an additional nine services. The missing data entry rate was 0.5-22.2%. The overall reported ETI success rate was 86.8% (92.8% for cardiac arrests and 76.8% for non-arrests) and did not appear to vary between population settings. There were two cases of delayed recognition of esophageal intubation, one case of unrecognized esophageal intubation, and 22 cases of tube dislodgement during patient care or transport. Bag-valve-mask ventilation was used as the rescue airway technique in the majority of failed ETI. When stratified for cardiac arrests vs. non-arrests, ETI success was not associated with field or initial ED survival.
We successfully obtained complete data for the majority of ETI attempted across multiple EMS services. Our data also indicate the need to address problems with non-response. Preliminary cross-sectional data highlight areas of current interest in out-of-hospital airway management.
以往院外气道管理数据受限于小规模、单中心设计。我们试图评估使用标准化数据收集工具对院外气管插管（ETI）进行前瞻性、多中心评估的可行性。
我们设计了一项前瞻性多中心观察性研究，涉及来自大西洋中部一个州的45个高级生命支持（ALS）服务机构。院前人员使用标准化数据表格报告每次尝试ETI的详细信息，包括患者人口统计学资料、使用的方法、遇到的困难以及患者初始结局。我们计算并评估了数据表格回复率（通过独立查询每个急救医疗服务机构尝试ETI的次数）和缺失数据录入率。我们还对当前院外ETI感兴趣的因素进行了初步横断面评估。未评估回复的准确性和有效性。数据集中存储并使用描述性技术进行分析。
参与者包括8个城市、15个郊区、20个农村和2个空中医疗服务机构。在2001年6月1日至2001年11月30日研究期间，共收到783例接受ETI尝试的成年患者的数据表格。汇总数据表格回复率为72.7%。每个服务机构的回复率范围为0至100%，每个服务机构回复率的中位数为75%。无回复（尝试插管后未返回数据表格）是个问题，有9个服务机构的数据回复率低于50%。另有9个服务机构无法计算数据回复率。缺失数据录入率为0.5%至22.2%。总体报告的ETI成功率为86.8%（心脏骤停患者为92.8%，非心脏骤停患者为76.8%），在不同人群环境中似乎没有差异。有2例食管插管识别延迟，1例未识别的食管插管，以及22例在患者护理或转运期间导管移位。在大多数失败的ETI中，使用袋阀面罩通气作为抢救气道技术。按心脏骤停与非心脏骤停分层时，ETI成功与现场或初始急诊科生存率无关。
我们成功获取了多个急救医疗服务机构大多数尝试ETI的完整数据。我们的数据还表明需要解决无回复问题。初步横断面数据突出了当前院外气道管理中感兴趣的领域。
