Helm M, Hossfeld B, Schlechtriemen T, Braun J, Lampl L, Bernhard M
Abteilung für Anästhesiologie & Intensivmedizin, Sektion Notfallmedizin, Bundeswehrkrankenhaus Ulm, Deutschland.
Anaesthesist. 2011 Dec;60(12):1119-25. doi: 10.1007/s00101-011-1937-5. Epub 2011 Sep 2.
Intraosseous infusion has become established as a fast and safe alternative to conventional vascular access in emergency situations. Originally the use of intraosseous access was limited to children up to 6 years of age and to adults for cardiopulmonary resuscitation but this limitation has now been removed. The aim of this study was to obtain data on mission reality regarding the use of intraosseous access in the prehospital setting against the background of the expanded recommendations on the use of the intraosseous infusion.
An analysis of rescue missions by all rescue helicopters of the ADAC (German Automobile Club) Air Rescue as well as the German Air Rescue Service (58 helicopter emergency medical service bases) over a 4 year period from January 2005 to December 2008 was carried out.
A total of 247,454 rescue missions were carried out during the study period and in 525 patients (0.2% of the total study collective) an intraosseous access was established. There was a significant increase in the intraosseous infusion rate from 0.1% to 0.4% (p<0.05). Furthermore, there was a significant increase in its use in elderly patients and in patients with lower National Advisory Committee for Aeronautics (NACA) scores (2005 vs. 2008): 92.4% vs. 42.9% of all intraosseous infusions in patients ≤ 6 years of age (p<0.05) and 74.4% vs. 42.9% of all intraosseous infusions in patients with NACA score VI/VII (p<0.05). The proportion of trauma patients in the total study collective was 33% and there was no significant change in the frequency of trauma cases over the study period but there was a remarkable increase of intraosseous infusions in trauma patients in the last year of the study period compared to the previous years (38% in 2008 vs. 27-30% in 2005-2007). Furthermore, there was an increase in the number of different drug groups used for intraosseous infusion over the study period.
The expanded indication recommendations for the use of intraosseous infusion in the prehospital setting enter more and more mission reality in air rescue services in Germany.
在紧急情况下，骨内输液已成为一种快速且安全的替代传统血管通路的方法。最初，骨内通路的使用仅限于6岁以下儿童以及用于成人的心肺复苏，但现在这一限制已被取消。本研究的目的是在骨内输液使用建议扩大的背景下，获取院前环境中骨内通路使用情况的实际任务数据。
对德国汽车俱乐部（ADAC）空中救援以及德国空中救援服务（58个直升机紧急医疗服务基地）的所有救援直升机在2005年1月至2008年12月的4年期间的救援任务进行分析。
在研究期间共执行了247,454次救援任务，525例患者（占研究总人群的0.2%）建立了骨内通路。骨内输液率从0.1%显著增加到0.4%（p<0.05）。此外，老年患者和美国国家航空咨询委员会（NACA）评分较低患者中其使用显著增加（2005年与2008年相比）：≤6岁患者中所有骨内输液的92.4%对42.9%（p<0.05），NACA评分VI/VII患者中所有骨内输液的74.4%对42.9%（p<0.05）。研究总人群中创伤患者的比例为33%，研究期间创伤病例的频率没有显著变化，但与前几年相比，研究期最后一年创伤患者的骨内输液显著增加（2008年为38%，2005 - 2007年为27% - 30%）。此外，研究期间用于骨内输液的不同药物组数量有所增加。
在德国空中救援服务中，院前环境下骨内输液使用的扩大适应症建议越来越多地进入实际任务中。
