Department of Emergency Medicine, University of Pittsburgh, Pennsylvania 15213, USA.
Prehosp Emerg Care. 2012 Apr-Jun;16(2):293-8. doi: 10.3109/10903127.2011.640764. Epub 2011 Dec 22.
Multiple studies have demonstrated varying rates of successful endotracheal intubation (ETI). Until the application of video laryngoscopy, little information regarding prehospital intubation could be analyzed objectively by individuals other than the provider performing the ETI.
To evaluate the association of variables recorded during video laryngoscopy and successful ETI attempts, defined as placing the endotracheal tube in the trachea.
We retrospectively reviewed intubations performed by a single helicopter emergency medical service (HEMS) using a video larygoscope from March 1, 2010, to October 1, 2010. All videos were de-identified and analyzed by a single researcher. Time intervals (e.g., attempt time) and intubation process variables (e.g., Cormack-Lehane [C-L] view) were abstracted from all videos. Time intervals were begun when the laryngoscope blade passed the lips and entered the oral cavity (entry). We describe variables using means and standard deviations (continuous), medians with interquartile ranges (ordinal), and percentages with 95% confidence intervals (categorical). We then looked at univariate associations between these variables and ETI success using logistic regression.
We recorded 116 intubations during the study period. Twenty-nine recordings were either incomplete (n = 26) or of insufficient quality for analysis (n = 3). The remaining 87 videos represented 87 different patients with a total of 102 attempts at laryngoscopy. Thirty-six providers performed 64 cases, with the majority of providers (n = 21) performing only one intubation. The first-pass success rate in this series was 76% (n = 66), with 98% success within three attempts. Successful ETI attempts had lower entry-to-percentage of glottic opening (POGO) times (16.6 sec vs. 32.1 sec, p = 0.013), entry-to-first view of the endotracheal tube or entry-to-tube times (17.6 sec vs. 27.4 sec, p = 0.04), higher POGO scores (76 vs. 39, p < 0.001), and a lower C-L view (one vs. three, p < 0.001). Recognized esophageal intubation was more likely to occur during unsuccessful ETI attempts (43% vs. 8%, p < 0.001).
Video laryngoscopy can measure multiple components of ETI performance. Successful ETI attempts have significantly shorter entry-to-POGO times and entry-to-tube times, obtain better views of the glottic opening (POGO and C-L view), and have a lower incidence of recognized esophageal intubation.
多项研究表明，气管插管（ETI）的成功率存在差异。在使用视频喉镜之前，除了进行 ETI 的提供者之外，其他人几乎无法客观地分析有关院前插管的信息。
评估视频喉镜记录的变量与气管插管成功（定义为将气管内导管插入气管）之间的关联。
我们回顾性分析了 2010 年 3 月 1 日至 2010 年 10 月 1 日期间由单一直升机紧急医疗服务（HEMS）使用视频喉镜进行的插管。所有视频均经过去识别，并由一位研究人员进行分析。从所有视频中提取时间间隔（例如尝试时间）和插管过程变量（例如 Cormack-Lehane [C-L] 视图）。当喉镜刀片通过嘴唇并进入口腔时（入口）开始计时。我们使用平均值和标准差（连续）、中位数和四分位间距（有序）以及百分比和 95%置信区间（分类）来描述变量。然后，我们使用逻辑回归检查这些变量与 ETI 成功之间的单变量关联。
在研究期间，我们记录了 116 次插管。有 29 个记录不完整（n = 26）或分析质量不足（n = 3）。其余 87 个视频代表 87 名不同的患者，总共进行了 102 次喉镜检查尝试。36 名提供者进行了 64 例，其中大多数提供者（n = 21）仅进行了一次插管。该系列的初次成功率为 76%（n = 66），三次尝试内成功率为 98%。成功的 ETI 尝试具有较短的入口至声门张开百分比（POGO）时间（16.6 秒与 32.1 秒，p = 0.013），入口至首次观察到气管内导管或入口至导管时间（17.6 秒与 27.4 秒，p = 0.04），较高的 POGO 评分（76 与 39，p < 0.001）和较低的 C-L 视图（1 与 3，p < 0.001）。未成功的 ETI 尝试中更可能发生食管插管识别（43%与 8%，p < 0.001）。
视频喉镜可测量 ETI 性能的多个组成部分。成功的 ETI 尝试具有明显更短的入口至 POGO 时间和入口至导管时间，获得更好的声门开口（POGO 和 C-L 视图），并具有较低的公认食管插管发生率。
