Timmermann A, Braun U, Panzer W, Schlaeger M, Schnitzker M, Graf B M
Zentrum Anaesthesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen.
Anaesthesist. 2007 Apr;56(4):328-34. doi: 10.1007/s00101-007-1153-5.
Out-of-hospital airway management confronts emergency medical teams with complex challenges. To date no specific data are available on the qualifications of emergency physicians (EPs) and the quality of emergency equipment in northern Germany.
This study surveyed individual EPs at regional emergency dispatch centres about their personal knowledge and skills, and the procedures and equipment used in out-of-hospital airway management.
A total of 606 EPs from 59 of the 66 (89.4%) regional emergency dispatch centres surveyed responded and 56.1% of the EPs questioned were anesthesiologists. The other EPs were qualified in either internal medicine (22.6%), surgery (12.4%), general medicine (5.6%) or other specialties (3.3%). All (100%) of the EPs trained in anesthesia and 35.2% of the other EPs reported that they had performed more than 100 in-hospital endotracheal intubations (ETI). 93% of all EPs rated out-of-hospital ETI as more difficult than in-hospital ETI. A total of 33.0% of anesthesia-trained EPs and 6.1% of the other EPs used muscle relaxants for ETI in more than 20% of the cases. Of the anesthesia-trained EPs 38.1% used expiratory CO(2) monitoring to verify tube placement compared to 12.1% of the other EPs. A total of 97.8% of anesthesia-trained EPs reported having used an extra-glottic airway device more than 20 times compared to 11.1% of the other EPs. For the emergency equipment 44.4% included an extraglottic airway device, 57.8% a cricothyrotomy set and 27.1% CO(2) monitoring options.
Neither the emergency equipment nor the physicians' knowledge and skills were sufficient to meet the special demands of out-of-hospital airway management, particularly among non-anesthesiologists.
院外气道管理给急诊医疗团队带来了复杂的挑战。迄今为止，德国北部尚无关于急诊医生资质和急救设备质量的具体数据。
本研究对地区急诊调度中心的急诊医生个人知识和技能，以及院外气道管理中使用的程序和设备进行了调查。
在接受调查的66个地区急诊调度中心中的59个（89.4%），共有606名急诊医生做出回应，其中56.1%的被调查急诊医生为麻醉医生。其他急诊医生分别具备内科（22.6%）、外科（12.4%）、普通医学（5.6%）或其他专业（3.3%）资质。所有接受过麻醉培训的急诊医生（100%）以及35.2%的其他急诊医生报告称，他们在医院内进行过100多次气管插管（ETI）操作。93%的急诊医生认为院外气管插管比院内气管插管更困难。在超过20%的病例中，33.0%接受过麻醉培训的急诊医生和6.1%的其他急诊医生在气管插管时使用了肌肉松弛剂。在接受过麻醉培训的急诊医生中，38.1%使用呼气末二氧化碳监测来确认导管位置，而其他急诊医生中这一比例为12.1%。97.8%接受过麻醉培训的急诊医生报告称使用声门外气道装置超过20次，而其他急诊医生中这一比例为11.1%。在急救设备方面，44.4%配备了声门外气道装置，57.8%配备了环甲膜切开器械包，27.1%配备了二氧化碳监测设备。
无论是急救设备还是医生的知识和技能，都不足以满足院外气道管理的特殊需求，尤其是在非麻醉医生中。
