Emergency Medical Care Program, 122 Moore Building, Western Carolina University, Cullowhee, NC 28723, USA.
Prehosp Emerg Care. 2010 Oct-Dec;14(4):515-30. doi: 10.3109/10903127.2010.497903.
Airway management is a key component of prehospital care for seriously ill and injured patients. Oral endotracheal intubation (OETI) is the definitive airway of choice in most emergency medical services (EMS) systems. However, OETI may not be an approved skill for some clinicians or may prove problematic in certain patients because of anatomic abnormalities, trauma, or inadequate relaxation. In these situations alternative airways are frequently employed. However, the reported success rates for these devices vary widely, and established benchmarks are lacking.
We sought to determine pooled estimates of the success rates of alternative airway devices (AADs) and needle cricothyrotomy (NCRIC) and surgical cricothyrotomy (SCRIC) placement through a meta-analysis of the literature.
We performed a systematic literature search for all English-language articles reporting success rates for AADs, SCRIC, and NCRIC. Studies of field procedures performed by prehospital personnel from any nation were included. All titles were reviewed independently by two authors using prespecified inclusion criteria. Pooled estimates of success rates for each airway technique were calculated using a random-effects meta-analysis model.
Of 2,005 prehospital airway titles identified, 35 unique studies were retained for analysis of AAD success rates, encompassing a total of 10,172 prehospital patients. The success rates for SCRIC and NCRIC were analyzed across an additional 21 studies totaling 512 patients. The pooled estimates (and 95% confidence intervals [CIs]) for intervention success across all clinicians and patients were as follows: esophageal obturator airway-esophageal gastric tube airway (EOA-EGTA) 92.6% (90.1%-94.5%); pharyngeotracheal lumen airway (PTLA) 82.1% (74.0%-88.0%); esophageal-tracheal Combitube (ETC) 85.4% (77.3%-91.0%); laryngeal mask airway (LMA) 87.4% (79.0%-92.8%); King Laryngeal Tube airway (King LT) 96.5% (71.2%-99.7%); NCRIC 65.8% (42.3%-83.59%); and SCRIC 90.5% (84.8%-94.2%).
We provide pooled estimates for prehospital AAD, NCRIC, and SCRIC airway interventions. Of the AADs, the King LT demonstrated the highest insertion success rate (96.5%), although this estimate is based on limited data, and data regarding its ventilatory effectiveness are lacking; more data are available for the ETC and LMA. The ETC, LMA, and PTLA all had similar-but lower-success rates (82.1%-87.4%). NCRIC has a low rate of success (65.8%); SCRIC has a much higher success rate (90.5%) and should be considered the preferred percutaneous rescue airway.
气道管理是危重病和创伤患者院前护理的关键组成部分。口腔气管内插管（OETI）是大多数紧急医疗服务（EMS）系统中首选的明确气道。然而，由于解剖异常、创伤或松弛不足，OETI 可能不是某些临床医生认可的技能，或者在某些患者中可能会出现问题。在这些情况下，通常会使用替代气道。然而，这些设备的报告成功率差异很大，缺乏既定的基准。
我们通过对文献进行荟萃分析，旨在确定替代气道设备（AAD）和针式环甲膜切开术（NCRIC）以及手术环甲膜切开术（SCRIC）放置的成功率的汇总估计。
我们对所有报告 AAD、SCRIC 和 NCRIC 成功率的英语文献进行了系统的文献检索。纳入了来自任何国家的院前人员进行现场操作的研究。所有标题均由两名作者独立使用预设纳入标准进行审查。使用随机效应荟萃分析模型计算每种气道技术的成功率汇总估计值。
在 2005 个院前气道标题中，确定了 35 项独特的研究用于分析 AAD 成功率，共纳入了 10172 名院前患者。SCRIC 和 NCRIC 的成功率是在另外 21 项共 512 名患者的研究中进行分析的。所有临床医生和患者的干预成功率的汇总估计值（和 95%置信区间 [CI]）如下：食管阻塞气道-食管胃管气道（EOA-EGTA）92.6%（90.1%-94.5%）；咽气管腔气道（PTLA）82.1%（74.0%-88.0%）；食管-气管 Combitube（ETC）85.4%（77.3%-91.0%）；喉罩气道（LMA）87.4%（79.0%-92.8%）；King 喉管气道（King LT）96.5%（71.2%-99.7%）；NCRIC 65.8%（42.3%-83.59%）；和 SCRIC 90.5%（84.8%-94.2%）。
我们提供了院前 AAD、NCRIC 和 SCRIC 气道干预的汇总估计值。在 AAD 中，King LT 显示出最高的插入成功率（96.5%），尽管这一估计基于有限的数据，并且缺乏关于其通气效果的数据；ETC 和 LMA 的数据更多。ETC、LMA 和 PTLA 的成功率相似（82.1%-87.4%）。NCRIC 的成功率较低（65.8%）；SCRIC 的成功率高得多（90.5%），应被视为首选的经皮抢救气道。
