Poste Jennifer C, Davis Daniel P, Ochs Mel, Vilke Gary M, Castillo Edward M, Stern Jessica, Hoyt David B
Air Med J. 2004 Jul-Aug;23(4):36-40. doi: 10.1016/j.amj.2004.04.006.
The San Diego Paramedic Rapid Sequence Intubation (RSI) Trial documented an increase in mortality with paramedic RSI of patients with severe traumatic brain injury. This analysis explores the impact of air medical transport of trial patients on outcome.
Adult trauma victims with severe traumatic brain injury (Glasgow Coma Scale score of 3 to 8) were prospectively enrolled. Paramedics performed RSI using midazolam and succinylcholine; air medical crews could be called at the discretion of ground paramedics, generally for anticipated prolonged transports. Patients were matched to historical controls using the following parameters: age, gender, mechanism, injury of severity score, and abbreviated injury scale scores for each body system. Patients transported by air and ground were compared with regard to demographics, clinical parameters, vital signs, arterial blood gas data, and outcome.
A total of 336 patients were included (79 air medical and 257 ground transports). No significant differences arose between the groups with regard to demographic, clinical, vital sign, and arterial blood gas data. Air medical patients had decreased mortality (28% vs 31%, OR 0.9), and ground patients had increased mortality versus matched controls (33% vs 22%, OR 1.8). Discordant groups analysis revealed a statistically significant effect of transport personnel on outcome (P=.009). Neither advanced procedures nor the use of mannitol accounted for the improved outcomes; air medical crews used capnometry to guide ventilation on all study patients.
Air medical transport of severely head-injured patients undergoing paramedic RSI was associated with improved outcomes. Improved ventilation by capnometry may account for part of these improvements.
圣地亚哥急救人员快速顺序诱导插管（RSI）试验记录了严重创伤性脑损伤患者接受急救人员RSI后死亡率增加的情况。本分析探讨了试验患者空中医疗转运对结局的影响。
前瞻性纳入患有严重创伤性脑损伤（格拉斯哥昏迷量表评分为3至8分）的成年创伤受害者。急救人员使用咪达唑仑和琥珀酰胆碱进行RSI；空中医疗机组人员可由地面急救人员酌情调用，通常用于预计的长时间转运。使用以下参数将患者与历史对照进行匹配：年龄、性别、受伤机制、损伤严重程度评分以及每个身体系统的简明损伤量表评分。比较了通过空中和地面转运的患者在人口统计学、临床参数、生命体征、动脉血气数据和结局方面的情况。
共纳入336例患者（79例空中医疗转运和257例地面转运）。两组在人口统计学、临床、生命体征和动脉血气数据方面没有显著差异。空中医疗转运的患者死亡率降低（28%对31%，比值比0.9），地面转运的患者与匹配对照组相比死亡率升高（33%对22%，比值比1.8）。不一致组分析显示转运人员对结局有统计学显著影响（P = 0.009）。高级程序和甘露醇的使用均不能解释结局的改善；空中医疗机组人员对所有研究患者均使用二氧化碳监测法来指导通气。
接受急救人员RSI的严重颅脑损伤患者的空中医疗转运与结局改善相关。通过二氧化碳监测法改善通气可能是这些改善的部分原因。
