James Dorsha N, Voskresensky Igor V, Jack Meg, Cotton Bryan A
Department of Emergency Medicine, Vanderbilt University School of Medicine, Nashville, TN, USA.
Resuscitation. 2009 Jun;80(6):650-7. doi: 10.1016/j.resuscitation.2009.02.020. Epub 2009 Apr 17.
Pre-hospital airway management represents the intervention most likely to impact outcomes in critically injured patients. As such, airway management issues dominate quality improvement (QI) reviews of aero-medical programs. The purpose of this study was to evaluate current practice patterns of airway management in trauma among U.S. aero-medical service (AMS) programs.
The Association of Air Medical Services (AAMS) Resource Guide from 2005 to 2006 was utilized to identify the e-mail addresses of all directors of U.S. aero-medical transport programs. Program directors from 182 U.S. aero-medical programs were asked to participate in an anonymous, web-based survey of emergency airway management protocols and practices. Non-responders to the initial request were contacted a second time by e-mail.
89 programs responded. 98.9% have rapid sequence intubation (RSI) protocols. 90% use succinylcholine, 70% use long-acting neuromuscular blockers (NMB) within their RSI protocol. 77% have protocols for mandatory in-flight sedation but only 13% have similar protocols for maintenance paralytics. 60% administer long-acting NMB immediately after RSI, 13% after confirmation of neurological activity. Given clinical scenarios, however, 97% administer long-acting NMB to patients with scene and in-flight Glasgow Coma Scale (GCS) of 3, even for brief transport times.
The majority of AMS programs have well defined RSI and in-flight sedation protocols, while protocols for in-flight NMB are uncommon. Despite this, nearly all programs administer long-acting NMB following RSI, irrespective of GCS or flight time. Given the impact of in-flight NMB on initial assessment, early intervention, and injury severity scoring, a critical appraisal of current AMS airway management practices appears warranted.
院前气道管理是对重伤患者预后影响最大的干预措施。因此，气道管理问题在航空医疗项目的质量改进（QI）评估中占据主导地位。本研究的目的是评估美国航空医疗服务（AMS）项目中创伤气道管理的当前实践模式。
利用2005年至2006年航空医疗服务协会（AAMS）资源指南确定美国所有航空医疗运输项目主任的电子邮件地址。邀请来自182个美国航空医疗项目的项目主任参与一项关于紧急气道管理方案和实践的匿名网络调查。对初次请求未回复者通过电子邮件再次联系。
89个项目做出了回应。98.9%有快速顺序诱导插管（RSI）方案。90%在其RSI方案中使用琥珀胆碱，70%使用长效神经肌肉阻滞剂（NMB）。77%有强制空中镇静方案，但只有13%有类似的维持性麻痹方案。60%在RSI后立即给予长效NMB，13%在确认神经活动后给予。然而，在给定临床场景下，97%会对现场和空中格拉斯哥昏迷量表（GCS）评分为3分的患者给予长效NMB，即使运输时间很短。
大多数AMS项目有明确的RSI和空中镇静方案，而空中NMB方案并不常见。尽管如此，几乎所有项目在RSI后都会给予长效NMB，无论GCS评分或飞行时间如何。鉴于空中NMB对初始评估、早期干预和损伤严重程度评分的影响，对当前AMS气道管理实践进行批判性评估似乎是必要的。
