Ambulance Victoria, Monash University School of Public Health and Preventive Medicine, The Alfred Hospital, Victoria, Australia.
Ann Surg. 2010 Dec;252(6):959-65. doi: 10.1097/SLA.0b013e3181efc15f.
To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital.
Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes.
In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge.
A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge.
In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
确定在严重创伤性脑损伤（TBI）患者中，与在医院进行插管相比，急救人员进行快速序贯插管是否能改善 6 个月时的神经功能预后。
严重 TBI 与高死亡率和长期发病率有关。昏迷的 TBI 患者通常需要进行气管内插管以保护气道、预防缺氧和控制通气。在许多地方，急救人员在到达医院之前进行插管。然而，目前尚不清楚这种方法是否能改善预后。
在一项前瞻性、随机、对照试验中，我们将城市环境中患有严重 TBI 的成年人分为两组，一组由急救人员在院前进行快速序贯插管，另一组由医生在医院急诊科进行插管。主要结局测量指标为 6 个月时的中位扩展格拉斯哥结局量表（GOSe）评分。次要终点为 6 个月时的有利与不利结局、重症监护和住院时间、以及存活至出院。
共有 312 名严重 TBI 患者被随机分配至急救人员快速序贯插管或医院插管组。急救人员插管的成功率为 97%。在 6 个月时，急救人员插管组的患者中位 GOSe 评分为 5 分（四分位距，1-6 分），而医院插管组的患者为 3 分（四分位距，1-6 分）（P=0.28）。在有利结局（GOSe 评分 5-8 分）方面，急救人员插管组 157 例患者中有 80 例（51%），而医院插管组 142 例患者中有 56 例（39%）（风险比，1.28；95%置信区间，1.00-1.64；P=0.046）。两组患者的重症监护或住院时间以及存活至出院方面均无差异。
在严重 TBI 成人患者中，与在医院进行插管相比，急救人员进行院前快速序贯插管可提高 6 个月时的有利神经功能结局发生率。
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