Brown Calvin A, Cox Kelly, Hurwitz Shelley, Walls Ron M
Brigham and Women's Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts.
University of Illinois-Peoria, Department of Emergency Medicine, Peoria, Illinois.
West J Emerg Med. 2014 Mar;15(2):188-93. doi: 10.5811/westjem.2013.11.18549.
Pre-hospital airway management is a key component of resuscitation although the benefit of pre-hospital intubation has been widely debated. We report a large series of pre-hospital emergency airway encounters performed by air-transport providers in a large, multi-state system.
We retrospectively reviewed electronic intubation flight records from an 89 rotorcraft air medical system from January 01, 2007, through December 31, 2009. We report patient characteristics, intubation methods, success rates, and rescue techniques with descriptive statistics. We report proportions with 95% confidence intervals and binary comparisons using chi square test with p-values <0.05 considered significant.
4,871 patients had active airway management, including 2,186 (44.9%) medical and 2,685 (55.1%) trauma cases. There were 4,390 (90.1%) adult and 256 (5.3%) pediatric (age ≤ 14) intubations; 225 (4.6%) did not have an age recorded. 4,703 (96.6%) had at least one intubation attempt. Intubation was successful on first attempt in 3,710 (78.9%) and was ultimately successful in 4,313 (91.7%). Intubation success was higher for medical than trauma patients (93.4% versus 90.3%, p=0.0001 JT test). 168 encounters were managed primarily with an extraglottic device (EGD). Cricothyrotomy was performed 35 times (0.7%) and was successful in 33. Patients were successfully oxygenated and ventilated with an endotracheal tube, EGD, or surgical airway in 4809 (98.7%) encounters. There were no reported deaths from a failed airway.
Airway management, predominantly using rapid sequence intubation protocols, is successful within this high-volume, multi-state air-transport system.
尽管院前气管插管的益处一直存在广泛争议，但院前气道管理是复苏的关键组成部分。我们报告了一个大型多州系统中航空运输提供者进行的一系列大量院前紧急气道处理情况。
我们回顾性分析了2007年1月1日至2009年12月31日期间一个拥有89架旋翼机的空中医疗系统的电子插管飞行记录。我们用描述性统计报告患者特征、插管方法、成功率和抢救技术。我们报告比例及其95%置信区间，并使用卡方检验进行二元比较，p值<0.05被认为具有统计学意义。
4871例患者接受了积极的气道管理，其中包括2186例（44.9%）内科病例和2685例（55.1%）创伤病例。有4390例（90.1%）成人和256例（5.3%）儿科（年龄≤14岁）患者接受了气管插管；225例（4.6%）未记录年龄。4703例（96.6%）至少进行了一次插管尝试。首次尝试插管成功3710例（78.9%），最终成功4313例（91.7%）。内科患者插管成功率高于创伤患者（93.4%对90.3%，p = 0.0001，JT检验）。168次处理主要使用声门外装置（EGD）。环甲膜切开术进行了35次（0.7%），成功33次。在4809次（98.7%）处理中，患者通过气管内导管、EGD或手术气道成功实现了氧合和通气。没有因气道处理失败导致死亡的报告。
在这个高流量、多州的航空运输系统中，主要使用快速顺序插管方案的气道管理是成功的。
