University Hospital Coventry and Warwickshire NHS Trust, Coventry, UK.
Emerg Med J. 2011 May;28(5):428-31. doi: 10.1136/emj.2009.086645. Epub 2010 Jul 26.
The use of rapid sequence induction and tracheal intubation (RSI) in the pre-hospital environment is controversial. Currently, it is felt that competence to perform RSI should be defined by skills in anaesthesia not by the primary speciality of a practitioner. This aim of the study was to evaluate the tracheal intubation success rate of doctors drawn from different clinical specialities performing RSI in the pre-hospital environment.
Retrospective review of all RSI performed by doctors operating on the Warwickshire and Northamptonshire Air Ambulance over a 5-year period. Tracheal intubation failure rates were calculated and analysed for proportional differences between groups by χ(2) and, where appropriate, Fisher's exact test.
4362 active missions were flown. RSI was performed in 200 cases (4.6%, 3.1/month). Successful intubation occurred in 194 cases, giving a failure rate of 3% (6 cases, 95% CI 0.6 to 5.3%). While no difference in failure rate was observed between emergency department (ED) staff and anaesthetists (2.73% (3/110, 95% CI 0 to 5.7%) vs 0% (0/55, 95% CI 0 to 0%); p=0.55), a significant difference was found when non-ED, non-anaesthetic staff (GP and surgical) were compared to anaesthetists (10.34% (3/29, 95% CI 0 to 21.4%) vs 0%; p=0.04). There was no significant difference associated with seniority of practitioner (p=0.65).
Non-anaesthetic practitioners have a higher tracheal intubation failure rate during pre-hospital RSI. This likely reflects a lack of training opportunities and infrequency of clinical experience. Strategies to improve pre-hospital airway management are required.
在院前环境中使用快速序列诱导和气管插管（RSI）存在争议。目前，人们认为进行 RSI 的能力应由麻醉技能来定义，而不是由从业者的主要专业来定义。本研究的目的是评估来自不同临床专业的医生在院前环境中进行 RSI 的气管插管成功率。
回顾性分析了 5 年内在沃里克郡和北安普顿郡空中救护队执行的所有 RSI。计算气管插管失败率，并通过卡方检验（χ²）和适当的 Fisher 精确检验对组间的比例差异进行分析。
共飞行了 4362 次任务。在 200 例（4.6%，3.1/月）中进行了 RSI。194 例成功插管，失败率为 3%（6 例，95%CI0.6 至 5.3%）。虽然急诊科（ED）工作人员和麻醉师之间的失败率没有差异（2.73%（3/110，95%CI0 至 5.7%）与 0%（0/55，95%CI0 至 0%）；p=0.55），但与麻醉师相比，非 ED、非麻醉专业人员（GP 和外科医生）的差异具有统计学意义（10.34%（3/29，95%CI0 至 21.4%）与 0%；p=0.04）。与医生的资历无关（p=0.65）。
非麻醉专业人员在院前 RSI 中气管插管失败率较高。这可能反映了培训机会不足和临床经验不足。需要制定策略来改善院前气道管理。
