Wong K B, Lui C T, Chan William Y W, Lau T L, Tang Simon Y H, Tsui K L
Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong.
Department of Accident and Emergency, Tuen Mun Hospital, Tuen Mun, Hong Kong; Auxiliary Medical Service, AMS Headquarters, 81 Princess Margaret Road, Hong Kong.
Hong Kong Med J. 2014 Aug;20(4):304-12. doi: 10.12809/hkmj134168. Epub 2014 Jun 6.
OBJECTIVE. Airway management and endotracheal intubation may be required urgently when a patient deteriorates in an ambulance or aircraft during interhospital transfer or in a prehospital setting. The objectives of this study were: (1) to compare the effectiveness of conventional intubation by Macintosh laryngoscope in a moving ambulance versus that in a static ambulance; and (2) to compare the effectiveness of inverse intubation and GlideScope laryngoscopy with conventional intubation inside a moving ambulance. DESIGN. Comparative experimental study. SETTING. The experiment was conducted in an ambulance provided by the Auxiliary Medical Service in Hong Kong. PARTICIPANTS. A group of 22 doctors performed endotracheal intubation on manikins with Macintosh laryngoscope in a static and moving ambulance. In addition, they performed conventional Macintosh intubation, inverse intubation with Macintosh laryngoscope, and GlideScope intubation in a moving ambulance in both normal and simulated difficult airways. MAIN OUTCOME MEASURES. The primary outcome was the rate of successful intubation. The secondary outcomes were time taken for intubation, subjective glottis visualisation grading, and eventful intubation (oesophageal intubation, intubation time >60 seconds, and incisor breakage) with different techniques or devices. RESULTS. In normal airways, conventional Macintosh intubation in a static ambulance (95.5%), conventional intubation in a moving ambulance (95.5%), as well as GlideScope intubation in a moving ambulance (95.5%) were associated with high success rates; the success rate of inverse intubation was comparatively low (54.5%; P=0.004). In difficult airways, conventional Macintosh intubation in a static ambulance (86.4%), conventional intubation in a moving ambulance (90.9%), and GlideScope intubation in a moving ambulance (100%) were associated with high success rates; the success rate of inverse intubation was comparatively lower (40.9%; P=0.034). CONCLUSIONS. En-route intubation in an ambulance by conventional Macintosh laryngoscopy is superior to inverse intubation unless the cephalad access is impossible. GlideScope laryngoscopy appears to be associated with lower rates of eventful intubation in difficult airways and has better laryngoscopic view versus inverse intubation.
目的。当患者在医院间转运过程中于救护车或飞机上，或在院前环境中病情恶化时，可能需要紧急进行气道管理和气管插管。本研究的目的是：（1）比较在移动救护车中与在静态救护车中使用麦金托什喉镜进行传统插管的有效性；（2）比较在移动救护车中反向插管和GlideScope喉镜检查与传统插管的有效性。设计。对比实验研究。地点。实验在香港辅助医疗服务提供的一辆救护车中进行。参与者。一组22名医生在静态和移动的救护车中使用麦金托什喉镜对人体模型进行气管插管。此外，他们在正常气道和模拟困难气道的移动救护车中进行传统麦金托什插管、使用麦金托什喉镜进行反向插管以及GlideScope插管。主要观察指标。主要观察指标是插管成功率。次要观察指标是插管所需时间、声门可视化主观分级以及不同技术或设备导致的复杂插管情况（食管插管、插管时间>60秒和门牙折断）。结果。在正常气道中，静态救护车中的传统麦金托什插管（95.5%）、移动救护车中的传统插管（95.5%）以及移动救护车中的GlideScope插管（95.5%）成功率都很高；反向插管的成功率相对较低（54.5%；P = 0.004）。在困难气道中，静态救护车中的传统麦金托什插管（86.4%）、移动救护车中的传统插管（90.9%）以及移动救护车中的GlideScope插管（100%）成功率都很高；反向插管的成功率相对较低（40.9%；P = 0.034）。结论。除非无法进行头端入路，否则在救护车中通过传统麦金托什喉镜进行途中插管优于反向插管。GlideScope喉镜检查在困难气道中似乎与复杂插管发生率较低相关，并且与反向插管相比具有更好的喉镜视野。
