McIntosh Scott E, Swanson Eric R, McKeone Anna, Barton Erik D
Division of Emergency Medicine, University of Utah, Salt Lake City, Utah 84132, USA.
Prehosp Emerg Care. 2008 Oct-Dec;12(4):438-42. doi: 10.1080/10903120802301518.
Prehospital providers are constantly challenged with the task of managing airways in unpredictable and often inhospitable environments. Air medical transport (AMT) crews must be prepared to work in restrictive spaces with limited resources while in the aircraft. This study examines flight crew success rate and circumstances surrounding airway management in different locations.
This was a retrospective analysis of intubations performed by a university-based air medical transport team from January 1, 1995, to May 31, 2007. Patient records and prospectively gathered airway management quality assurance data were reviewed for location of intubation, patient characteristics, and success rates. Success was defined as placing a cuffed tube in the trachea nonsurgically.
Nine hundred thirty-eight patients required 939 advanced airway management procedures, and 936 cases had information sufficient for analysis. Six hundred twenty-seven (67%) of these intubations took place on scene, 235 (25.1%) at the referring hospital, 67 en-route (7.2%), and seven (0.7%) at the receiving hospital. The overall intubation success rate was 96% and the highest rate was for hospital intubations (98.8%), followed by scene (94.9%) and en-route (89.6%) airway encounters. Intubation success was more likely in the hospital setting (odds ratio [OR] = 8.7, 95% confidence interval [CI] 2.2-35.0, p = 0.002] and on the scene [OR = 2.3, 95% CI 0.95-5.7, p = 0.065] compared with those en-route. Unanticipated patient deterioration was noted as the most common reason for in-flight airway management. Type of aircraft was not significantly associated with intubation success (p = 0.132).
Airway management was performed with a high success rate in a variety of locations and patient characteristics by our air medical crew. When in the hospital environment, flight crew success rates were comparable to those of other emergency personnel. Caution should be used, however, when considering intubating in-flight because of slightly lower success rates.
院前急救人员在不可预测且通常条件恶劣的环境中进行气道管理时面临着持续的挑战。空中医疗运输（AMT）机组人员在飞机上必须准备好在资源有限的狭窄空间内工作。本研究调查了不同地点飞行机组人员的成功率以及气道管理的相关情况。
这是一项对某大学空中医疗运输团队在1995年1月1日至2007年5月31日期间进行的插管操作的回顾性分析。回顾患者记录以及前瞻性收集的气道管理质量保证数据，以了解插管位置、患者特征和成功率。成功定义为通过非手术方式将带套囊的气管导管置入气管。
938例患者需要进行939次高级气道管理操作，其中936例病例的信息足以进行分析。这些插管操作中，627例（67%）在现场进行，235例（25.1%）在转诊医院进行，67例（7.2%）在途中进行，7例（0.7%）在接收医院进行。总体插管成功率为96%，医院内插管成功率最高（98.8%），其次是现场（94.9%）和途中（89.6%）的气道操作。与途中相比，在医院环境中插管成功的可能性更大（优势比[OR]=8.7，95%置信区间[CI]2.2 - 35.0，p = 0.002），在现场也是如此（OR = 2.3，95%CI 0.95 - 5.7，p = 0.065）。飞行中气道管理最常见的原因是患者意外病情恶化。飞机类型与插管成功率无显著相关性（p = 0.132）。
我们的空中医疗机组人员在各种地点和不同患者特征情况下进行气道管理时成功率较高。在医院环境中，飞行机组人员的成功率与其他急救人员相当。然而，由于飞行中插管成功率略低，进行飞行中插管时应谨慎。
