高级气道管理并不能改善院外心脏骤停的预后。
Advanced airway management does not improve outcome of out-of-hospital cardiac arrest.
机构信息
Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA, USA.
出版信息
Acad Emerg Med. 2010 Sep;17(9):926-31. doi: 10.1111/j.1553-2712.2010.00829.x.
BACKGROUND
The goal of out-of-hospital endotracheal intubation (ETI) is to reduce mortality and morbidity for patients with airway and ventilatory compromise. Yet several studies, mostly involving trauma patients, have demonstrated similar or worse neurologic outcomes and survival-to-hospital discharge rates after out-of-hospital ETI. To date, there is no study comparing out-of-hospital ETI to bag-valve-mask (BVM) ventilation for the outcome of survival to hospital discharge among nontraumatic adult out-of-hospital cardiac arrest (OOHCA) patients.
OBJECTIVES
The objective was to compare survival to hospital discharge among adult OOHCA patients receiving ETI to those managed with BVM.
METHODS
In this retrospective cohort study, the records of all OOHCA patients presenting to a municipal teaching hospital from November 1, 1994, through June 30, 2008, were reviewed. The type of field airway provided, age, sex, race, rhythm on paramedic arrival, presence of bystander cardiopulmonary resuscitation (CPR), whether the arrest was witnessed, site of arrest, return of spontaneous circulation (ROSC), survival to hospital admission, comorbid illnesses, and survival to hospital discharge were noted. A univariate odds ratio (OR) was first computed to describe the association between the type of airway and survival to hospital discharge. A multivariable logistic regression analysis was performed, adjusting for rhythm, bystander CPR, and whether the arrest was witnessed.
RESULTS
A cohort of 1,294 arrests was evaluated. A total of 1,027 (79.4%) received ETI, while 131 (10.1%) had BVM, 131 (10.1%) had either a Combitube or an esophageal obturator airway, and five (0.4%) had incomplete prehospital records. Fifty-five of 1,294 (4.3%) survived to hospital discharge; there were no survivors in the Combitube/esophageal obturator airway cohort. Even after multivariable adjustment for age, sex, site of arrest, bystander CPR, witnessed arrest, and rhythm on paramedic arrival, the OR for survival to hospital discharge for BVM versus ETI was 4.5 (95% confidence interval [CI] = 2.3-8.9; p<0.0001).
CONCLUSIONS
In this cohort, when compared to BVM ventilation, advanced airway methods were associated with decreased survival to hospital discharge among adult nontraumatic OOHCA patients.
背景
院外气管插管（ETI）的目标是降低气道和通气受损患者的死亡率和发病率。然而，几项研究，主要涉及创伤患者，已经证明了在院外 ETI 后，神经功能结局和存活至出院率相似或更差。迄今为止，尚无研究比较院外 ETI 与球囊面罩通气（BVM）在非创伤性成人院外心脏骤停（OOHCA）患者出院存活率方面的结果。
目的
比较接受 ETI 的成年 OOHCA 患者与接受 BVM 治疗的患者的存活至出院率。
方法
在这项回顾性队列研究中，回顾了 1994 年 11 月 1 日至 2008 年 6 月 30 日期间向一家市教学医院就诊的所有 OOHCA 患者的记录。记录提供的现场气道类型、年龄、性别、种族、急救人员到达时的节律、是否存在旁观者心肺复苏（CPR）、是否有目击者、是否出现自主循环恢复（ROSC）、存活至入院、合并症以及存活至出院情况。首先计算单变量比值比（OR）来描述气道类型与存活至出院之间的关联。进行多变量逻辑回归分析，调整节律、旁观者 CPR 和是否有目击者。
结果
评估了 1294 例复苏。共有 1027 例（79.4%）接受了 ETI，131 例（10.1%）接受了 BVM，131 例（10.1%）使用了 Combitube 或食管堵塞气道，5 例（0.4%）的院前记录不完整。1294 例中有 55 例（4.3%）存活至出院；Combitube/食管堵塞气道组无幸存者。即使在多变量调整年龄、性别、发病部位、旁观者 CPR、目击者逮捕和急救人员到达时的节律后，BVM 与 ETI 相比，存活至出院的 OR 为 4.5（95%置信区间[CI] = 2.3-8.9；p<0.0001）。
结论
在本队列中，与 BVM 通气相比，高级气道方法与非创伤性 OOHCA 成年患者存活至出院率降低相关。
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