Martin-Gill Christian, Prunty Heather A, Ritter Seth C, Carlson Jestin N, Guyette Francis X
Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States.
Department of Emergency Medicine, University of Pittsburgh, Iroquois Building, Suite 400A, 3600 Forbes Avenue, Pittsburgh, PA 15261, United States.
Resuscitation. 2015 Jan;86:25-30. doi: 10.1016/j.resuscitation.2014.10.015. Epub 2014 Nov 1.
Laryngeal tube (LT) airways are commonly used in the prehospital setting, but there are limited data on clinical success rates across emergency medical services (EMS) agencies. We aimed to determine factors associated with unsuccessful LT placement in the prehospital setting.
We retrospectively reviewed all King LT placement attempts by prehospital providers in 35 ground advanced life support EMS agencies and one air medical critical care service with 17 rotorwing bases, between January 1, 2006 and August 31, 2011. Success of King LT placement and patient, procedural, and agency factors present were identified using descriptive statistics. Factors associated with unsuccessful laryngeal tube placement were identified using multivariable logistic regression.
During the study period, we observed 511 attempts at laryngeal tube placement by paramedics or prehospital nurses in 477 patients. Unsuccessful LT placement occurred in 15.1% of first attempts and 9.9% of cases overall. The majority (79.2%) of first attempts occurred as a rescue airway after unsuccessful endotracheal intubation attempt(s), in patients with non-traumatic complaints (70.9%) and in cardiac arrest (60.8%). Gag reflex (OR 4.08, 95% CI 1.72-9.67), ground (versus air) EMS agency (OR 2.49, 95% CI 1.07-5.79), and male gender (OR 1.90, 95% CI 1.04-3.46) were associated with unsuccessful LT placement in our multivariable model.
The laryngeal tube is an effective airway management tool for both advanced life support and critical care prehospital providers. Gag reflex, ground (versus air) EMS agency, and male gender were associated with unsuccessful laryngeal tube placement by prehospital personnel.
喉管（LT）气道在院前急救中常用，但关于各紧急医疗服务（EMS）机构临床成功率的数据有限。我们旨在确定院前环境中喉管放置失败的相关因素。
我们回顾性分析了2006年1月1日至2011年8月31日期间，35个地面高级生命支持EMS机构和1个拥有17个旋翼机基地的空中医疗重症护理服务机构的院前急救人员进行的所有King LT放置尝试。通过描述性统计确定King LT放置的成功率以及存在的患者、操作和机构因素。使用多变量逻辑回归确定与喉管放置失败相关的因素。
在研究期间，我们观察到护理人员或院前护士对477例患者进行了511次喉管放置尝试。首次尝试中15.1%的喉管放置失败，总体病例中9.9%失败。大多数首次尝试（79.2%）是在气管插管尝试失败后作为抢救气道进行的，发生在非创伤性主诉患者（70.9%）和心脏骤停患者（60.8%）中。在我们的多变量模型中，咽反射（比值比4.08，95%置信区间1.72 - 9.67）、地面（相对于空中）EMS机构（比值比2.49，95%置信区间1.07 - 5.79）和男性性别（比值比1.90，95%置信区间1.04 - 3.46）与喉管放置失败相关。
喉管是高级生命支持和院前重症护理人员有效的气道管理工具。咽反射、地面（相对于空中）EMS机构和男性性别与院前人员喉管放置失败相关。
