University Hospital Coventry and Warwick, NHS Trust, UK.
Resuscitation. 2009 Dec;80(12):1342-5. doi: 10.1016/j.resuscitation.2009.07.023. Epub 2009 Sep 4.
Paramedic tracheal intubation has been reported to carry a high failure rate and morbidity. A comparison between doctor and paramedic-led intubation at out-of-hospital cardiac arrests (OHCA) was conducted to assess whether this finding was observed in our clinical practice.
Retrospective review of all medical OHCA attended by the Warwickshire and Northamptonshire Air Ambulance (WNAA) over a 64-month period. Cases were identified and divided into doctor-led or paramedic-led groups. Self-reported intubation failure rate, morbidity and clinical outcome were observed and compared. Paramedic exposure to tracheal intubation was assessed.
286 cases of medical OHCA were identified, 199 (69.6%) were doctor-led and 87 (30.4%) paramedic-led. Paramedic and doctor-led crews intubated an equivalent proportion of cases (Para-led 60.7% [37] vs. Dr-led 62.8% [98]; p=0.89) and no significant difference in failure rate was observed (Para-led 2.7% [1 case, 95% CI 0.0-7.9%] vs. Dr-led 3.1% [3 cases, 95% CI 0.0-6.5%]; p=1). No morbidity from failure-to-intubate was recorded, and equal rates of return of spontaneous circulation (ROSC) were observed (Para-led 20.7% [18] vs. Dr-led 20.6% [41]; p=0.89). Paramedics operating with the WNAA were found to have a higher exposure to tracheal intubation (WNAA 0.03 TT/shift vs. unselected paramedics 0.004 TT/shift).
Experienced paramedics regularly operating with physicians have a low tracheal intubation failure rate at OHCA, whether practicing independently or as part of a doctor-led team. This is likely due to increased and regular clinical exposure.
有报道称，急救人员进行气管插管的失败率和发病率都很高。本研究比较了院外心脏骤停（OHCA）中医生和急救人员主导的插管，以评估这一发现是否在我们的临床实践中观察到。
回顾性分析了在沃里克郡和北安普顿郡空中救护队（WNAA）服务的 64 个月期间所有医疗 OHCA 病例。确定病例并分为医生主导或急救人员主导的小组。观察并比较自我报告的插管失败率、发病率和临床结局。评估急救人员进行气管插管的情况。
共确定了 286 例医疗 OHCA 病例，其中 199 例（69.6%）由医生主导，87 例（30.4%）由急救人员主导。急救人员和医生主导的小组插管的病例比例相当（Para-led 60.7%[37] vs. Dr-led 62.8%[98]；p=0.89），且失败率无显著差异（Para-led 2.7%[1 例，95%CI0.0-7.9%] vs. Dr-led 3.1%[3 例，95%CI0.0-6.5%]；p=1）。未记录到因未能插管而导致的并发症，且观察到的自主循环恢复（ROSC）率相等（Para-led 20.7%[18] vs. Dr-led 20.6%[41]；p=0.89）。与未经选择的急救人员相比，与 WNAA 一起工作的急救人员进行气管插管的频率更高（WNAA 0.03 TT/shift 与未经选择的急救人员 0.004 TT/shift）。
在 OHCA 中，经验丰富的急救人员经常与医生一起进行气管插管，失败率较低，无论是独立操作还是作为医生主导团队的一部分。这可能是由于增加了和常规的临床暴露。
