Gerritse Bastiaan M, Draaisma Jos M Th, Schalkwijk Annelies, van Grunsven Pierre M, Scheffer Gert Jan
Department of Anaesthesiology, Amphia Hospital, Postbus 90158, 4800 RK Breda, The Netherlands.
Resuscitation. 2008 Nov;79(2):225-9. doi: 10.1016/j.resuscitation.2008.05.016. Epub 2008 Aug 6.
To determine the incidence and success rate of out-of-hospital tracheal intubation (TI) and ventilation of children, taking account of the type of healthcare provider involved.
A prospective observational study to analyse a consecutive group of children for which a helicopter-transported medical team (HMT) was called. In all cases, the emergency medical service (EMS)-paramedics arrived at the scene first. Data regarding type of incident, physiological parameters, treatment, and survival until hospital discharge were collected and subsequently analysed.
Of the 300 children examined and treated by the HMT on scene, 155 (52%) children required out-of-hospital tracheal intubation. Ninety-five children had an initial Glasgow Coma Scale (GCS) rating of 3-4: the EMS-paramedics performed bag-valve-mask-ventilation (BVMV) until arrival with subsequent TI carried out by the HMT (54 children, survival 63%) or the EMS-paramedics performed TI themselves (41 children, subsequent correction of tube/ventilation by HMT in 37% and survival rate 5%). Two hundred and five children had an initial GCS of 5-15, from which 60 children required TI (survival rate 67%) and 145 children required no TI (survival rate 100%).
We do not recommend early TI by EMS-paramedics in children with a GCS of 3-4. The rate of complications of this procedure is unacceptably high. BVMV is the preferred choice for ventilation by paramedics, whenever possible. Out-of-hospital TI performed by HMT is safe and effective. The HMT has skills in advanced airway management not provided by the EMS.
考虑到参与的医疗服务提供者类型，确定儿童院外气管插管（TI）及通气的发生率和成功率。
一项前瞻性观察性研究，分析一组连续的呼叫直升机转运医疗队（HMT）的儿童。在所有病例中，紧急医疗服务（EMS）护理人员先到达现场。收集有关事件类型、生理参数、治疗及直至出院的生存情况的数据，随后进行分析。
在现场接受HMT检查和治疗的300名儿童中，155名（52%）儿童需要院外气管插管。95名儿童初始格拉斯哥昏迷量表（GCS）评分为3 - 4分：EMS护理人员进行袋阀面罩通气（BVMV）直至HMT到达，随后由HMT进行气管插管（54名儿童，生存率63%），或EMS护理人员自行进行气管插管（41名儿童，37%随后由HMT纠正导管/通气，生存率5%）。205名儿童初始GCS为5 - 15分，其中60名儿童需要气管插管（生存率67%），145名儿童不需要气管插管（生存率100%）。
我们不建议EMS护理人员对GCS为3 - 4分的儿童进行早期气管插管。该操作的并发症发生率高得令人无法接受。只要有可能，BVMV是护理人员通气的首选方法。HMT进行的院外气管插管安全有效。HMT具备EMS所没有的高级气道管理技能。
