强化医生监督对院前快速序贯气管插管计划的影响。

Effect of intensive physician oversight on a prehospital rapid-sequence intubation program.

机构信息

Department of Emergency Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY 14642, USA. jeremy

出版信息

Prehosp Emerg Care. 2010 Jul-Sep;14(3):310-6. doi: 10.3109/10903121003760200.

DOI:10.3109/10903121003760200

PMID:20397866

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2946630/

Abstract

OBJECTIVE

To examine the effects of adding close concurrent and retrospective physician oversight, consistent with National Association of EMS Physicians (NAEMSP) recommendations, to an existing regional prehospital rapid-sequence intubation (RSI) program.

METHODS

This study involved a retrospective cohort of patients receiving RSI between January 1, 2004, and July 31, 2008. On January 1, 2007, an updated program including additional concurrent and retrospective physician oversight, increased RSI-specific continuing medical education, and cadaver laboratory training was implemented. Study patients were divided into a preintervention group (group 1) and a postintervention group (group 2) based on date of medical care. Data regarding baseline characteristics, airway management, medication usage, and performance factors were compared between the groups. A retrospective review by two emergency medical services (EMS) physicians assessed whether the RSI was "clearly indicated" based on a predetermined set of criteria.

RESULTS

There were 109 RSIs performed in group 1 and 54 in group 2. Absolute increases in the use of both basic life support (BLS) (5%, p = 0.2) and advanced life support (ALS) (41%, p = 0.001) airway techniques were observed. Increases in postintubation administration of midazolam (30%, p = 0.001) and morphine (24%, p = 0.001) and a decrease for vecuronium (-28%, p = 0.001) were observed. There was no statistically significant difference in the intubation success rates (92% vs. 94%) and the frequencies of recognized esophageal endotracheal tube (ETT) placement (5% vs. 6%). The number of unrecognized esophageal ETT placements remained zero. Physician chart review demonstrated an absolute increase in "clearly indicated" RSIs (17%, p = 0.01).

CONCLUSIONS

Close concurrent and retrospective physician oversight consistent with recommendations from the NAEMSP is associated with improved cognitive skills in paramedics, including appropriate patient selection for RSI. Further research is warranted to validate this model and optimize where resources are best used to enhance patient safety and improve clinical management for this controversial paramedic skill.

摘要

目的

研究在现有的区域院前快速序贯插管（RSI）计划中增加符合国家急诊医师协会（NAEMSP）建议的密切同时和回顾性医师监督对其产生的影响。

方法

本研究涉及了一组 2004 年 1 月 1 日至 2008 年 7 月 31 日期间接受 RSI 的患者的回顾性队列。2007 年 1 月 1 日，实施了一项更新的计划，其中包括增加同期和回顾性医师监督、增加 RSI 特定的继续教育以及尸体实验室培训。根据医疗日期，研究患者分为干预前组（第 1 组）和干预后组（第 2 组）。比较两组之间的基线特征、气道管理、用药情况和操作因素。两名急诊医疗服务（EMS）医师进行回顾性审查，根据预定的一套标准评估 RSI 是否“明确指征”。

结果

第 1 组中有 109 例 RSI，第 2 组中有 54 例。基础生命支持（BLS）（5%，p=0.2）和高级生命支持（ALS）（41%，p=0.001）气道技术的使用绝对增加。插管后咪达唑仑（30%，p=0.001）和吗啡（24%，p=0.001）的给药增加，而维库溴铵（-28%，p=0.001）的给药减少。插管成功率（92%对 94%）和识别食管内气管插管（ETT）位置的频率（5%对 6%）无统计学差异。未识别的食管 ETT 位置仍为零。医师图表审查显示“明确指征”的 RSI 绝对增加（17%，p=0.01）。