Hillel Alexander T, Pandian Vinciya, Mark Lynette J, Clark James, Miller Christina R, Haut Elliott R, Cover Renee, Berkow Lauren C, Agrawal Yuri, Bhatti Nasir
Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, U.S.A.
Laryngoscope. 2015 Mar;125(3):640-4. doi: 10.1002/lary.24949. Epub 2014 Sep 24.
OBJECTIVES/HYPOTHESIS: The Difficult Airway Response Team (DART) was implemented in July 2008 to address emergent difficult airway situations. The main objective of this study was to highlight the unique role and skill set that otolaryngologists bring and their impact on patient outcomes.
Retrospective review of prospectively collected data from the hospital's airway registry.
We collected data on demographics, airway characteristics, airway management techniques used by each specialty, and clinical outcomes (such as cricothyrotomies) for patients for whom a code was activated between July 2006 and June 2010. We compared data between pre- and post-DART cohorts and between DART and non-DART patients using a matched case-control approach.
Of the 2,826 codes, 90 patients required DART management between July 2008 and June 2010. Body mass index, cervical spine injury/fixation, history of difficult airway, head and neck mass, and oropharyngeal and/or supraglottic angioedema were identified as significant predictors for DART activation. Forty-nine (60%) patients' airways were secured by anesthesiologists, 30 (36%) by otolaryngologists, and three (4%) by trauma surgeons. Otolaryngologists were able to use specialized techniques such as Holinger and Dedo laryngoscopes to significantly decrease the number of cricothyrotomies from seven (0.73%) pre-DART implementation to four (0.21%) post-DART implementation.
Otolaryngologists were able to decrease the need for cricothyrotomies using specialized techniques for patients with difficult airways. Otolaryngologists bring a special skill set to the DART that is beyond the scope of anesthesiologists and trauma surgeons and that can improve patient outcomes by preventing unnecessary emergency surgical airways.
目的/假设：困难气道反应小组（DART）于2008年7月成立，以应对紧急困难气道情况。本研究的主要目的是突出耳鼻喉科医生所具备的独特作用和技能组合及其对患者预后的影响。
对前瞻性收集的医院气道登记数据进行回顾性分析。
我们收集了2006年7月至2010年6月期间激活急救代码的患者的人口统计学数据、气道特征、各专业使用的气道管理技术以及临床结局（如环甲膜切开术）。我们采用匹配病例对照方法比较了DART小组前后队列之间以及DART小组与非DART小组患者之间的数据。
在2826次急救代码激活中，2008年7月至2010年6月期间有90名患者需要DART小组进行管理。体重指数、颈椎损伤/固定、困难气道病史、头颈部肿物以及口咽和/或声门上血管性水肿被确定为DART小组激活的重要预测因素。49名（60%）患者的气道由麻醉医生确保安全，30名（36%）由耳鼻喉科医生确保安全，3名（4%）由创伤外科医生确保安全。耳鼻喉科医生能够使用诸如霍林格喉镜和德多喉镜等专业技术，将环甲膜切开术的数量从DART小组实施前的7例（0.73%）显著减少至实施后的4例（0.21%）。
耳鼻喉科医生能够使用专业技术减少困难气道患者对环甲膜切开术的需求。耳鼻喉科医生为DART小组带来了麻醉医生和创伤外科医生范围之外的特殊技能组合，可通过避免不必要的紧急手术气道来改善患者预后。
