Levitan Richard M, Rosenblatt Boaz, Meiner Evan M, Reilly Patrick M, Hollander Judd E
Department of Emergency Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
Ann Emerg Med. 2004 Jan;43(1):48-53. doi: 10.1016/s0196-0644(03)00638-3.
We compare laryngoscopy performance and overall intubation success in trauma airways when primary airway management alternated between emergency medicine and anesthesia residents on an every-other-day basis.
Data on all trauma intubations during approximately 3 years were prospectively collected. Primary airway management was assigned to emergency department (ED) residents on even days and anesthesia residents on odd days. Emergency medicine residents intubated patients who arrived without notification or who needed immediate intubation before anesthesia arrived. The study was conducted in an inner-city, Level I trauma center with approximately 50,000 ED patients and 1,800 major trauma cases a year. Main outcomes were success or failure at laryngoscopy and the number of laryngoscopy attempts needed for intubation.
Six hundred fifty-eight trauma patients were intubated during the study period. Laryngoscopy was successful in 654 of 656 cases. Two (0.3%) patients underwent cricothyrotomy after failed laryngoscopy, and 2 (0.3%) patients had awake nasal intubation without laryngoscopy. The specific number of laryngoscopy attempts was unknown in 6 cases (3 from each service), resulting in 650 cases for laryngoscopy performance analysis. Overall, 87% of patients were intubated on first attempt, and 3 or more attempts occurred in 2.9% of patients. Laryngoscopy performance by service (broken down by 1, 2, and >or=3 attempts) was as follows: emergency medicine 86.4%, 11%, and 2.6% versus anesthesia 89.7%, 6.7%, and 3.6%. Analysis by service was done by using Wilcoxon Mann-Whitney testing (P=.225).
There were no differences in laryngoscopy performance and intubation success in trauma airways managed on an every-other-day basis by emergency medicine versus anesthesia residents.
我们比较了在创伤气道管理中，当急诊医学住院医师和麻醉科住院医师每隔一天交替进行主要气道管理时的喉镜检查操作情况和总体插管成功率。
前瞻性收集了大约3年期间所有创伤插管的数据。主要气道管理在偶数日分配给急诊科（ED）住院医师，奇数日分配给麻醉科住院医师。急诊医学住院医师对未提前通知到达或在麻醉科人员到达前需要立即插管的患者进行插管。该研究在一个市中心的一级创伤中心进行，该中心每年约有50000名急诊科患者和l800例严重创伤病例。主要结局指标为喉镜检查成功或失败以及插管所需的喉镜检查尝试次数。
在研究期间，658例创伤患者接受了插管。656例中有654例喉镜检查成功。2例（0.3%）患者在喉镜检查失败后行环甲膜切开术，2例（0.3%）患者未行喉镜检查而行清醒鼻腔插管。6例（每个科室3例）患者的喉镜检查尝试具体次数不详，因此有650例患者可用于喉镜检查操作分析。总体而言，87%的患者首次尝试插管成功，2.9%的患者进行了3次或更多次尝试。各科室的喉镜检查操作情况（按1次、2次和≥3次尝试分类）如下：急诊医学科分别为86.4%、11%和2.6%，麻醉科分别为89.7%、6.7%和3.6%。采用Wilcoxon Mann-Whitney检验进行各科室分析（P = 0.225）。
由急诊医学住院医师和麻醉科住院医师每隔一天交替管理的创伤气道，在喉镜检查操作情况和插管成功率方面没有差异。
