Tollefsen William Wallace, Brown Calvin A, Cox Kelly L, Walls Ron M
From the *Department of Emergency Medicine, Brigham and Women's Hospital; †Harvard-Affiliated Emergency Medicine Residency;‡Department of Emergency Medicine, University of Massachusetts, Worcester; §Division of Emergency Medicine, Harvard Medical School, Boston, MA; and ∥Department of Emergency Medicine, University of Illinois, Peoria, IL.
Pediatr Emerg Care. 2013 Sep;29(9):963-8. doi: 10.1097/PEC.0b013e3182a219ea.
Effective airway management is the cornerstone of resuscitative efforts for any critically ill or injured patient. The role and safety of pediatric prehospital intubation is controversial, particularly after prior research has shown varying degrees of intubation success. We report a series of consecutive prehospital pediatric intubations performed by air-transport providers.
We retrospectively reviewed intubation flight records from an 89-rotorcraft, multistate emergency flight service during the time period from January 1, 2007, to December 31, 2009. All patients younger than 15 years were included in our analysis. We characterized patient, flight, and operator demographics; intubation methods; success rates; rescue techniques; and adverse events with descriptive statistics. We report proportions with 95% confidence intervals and differences between groups with Fisher exact and χ tests; P < 0.05 was considered significant.
Two hundred sixty pediatric intubations were performed consisting of 88 medical (33.8%) and 172 trauma (66.2%) cases; 98.8% (n = 257) underwent an orotracheal intubation attempt as the first method. First-pass intubation success was 78.6% (n = 202), and intubation was ultimately successful in 95.7% (n = 246) of cases. Medical and trauma intubations had similar success rates (98% vs 95%, Fisher exact test P = 0.3412). There was no difference in intubation success between age groups (χ = 0.26, P = 0.88). Three patients were managed primarily with an extraglottic device. Rescue techniques were used in 11 encounters (4.2%), all of which were successful. Cricothyrotomy was performed twice, both successful.
Prehospital pediatric intubation performed by air-transport providers, using rapid sequence intubation protocols, is highly successful. This effect on patient outcome requires further study.
有效的气道管理是任何危重病或受伤患者复苏努力的基石。儿科院前插管的作用和安全性存在争议，尤其是在先前的研究显示插管成功率存在不同程度的差异之后。我们报告了一系列由空中运输服务提供者进行的连续的儿科院前插管情况。
我们回顾性分析了2007年1月1日至2009年12月31日期间一家拥有89架旋翼机的多州紧急飞行服务机构的插管飞行记录。所有15岁以下的患者均纳入我们的分析。我们用描述性统计方法对患者、飞行和操作人员的人口统计学特征、插管方法、成功率、抢救技术和不良事件进行了描述。我们报告比例及其95%置信区间，以及组间差异（采用Fisher精确检验和χ检验）；P<0.05被认为具有统计学意义。
共进行了260例儿科插管，其中医疗病例88例（33.8%），创伤病例172例（66.2%）；98.8%（n = 257）的患者首次尝试经口气管插管。首次插管成功率为78.6%（n = 202），最终插管成功率为95.7%（n = 246）。医疗和创伤插管的成功率相似（98%对95%，Fisher精确检验P = 0.3412）。各年龄组插管成功率无差异（χ = 0.26，P = 0.88）。3例患者主要使用声门外装置进行处理。11次（4.2%）插管使用了抢救技术且均成功。环甲膜切开术进行了2次，均成功。
空中运输服务提供者采用快速顺序插管方案进行的儿科院前插管成功率很高。其对患者预后的影响需要进一步研究。
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