Brown Calvin A, Bair Aaron E, Pallin Daniel J, Walls Ron M
Department of Emergency Medicine, Brigham and Women's Hospital, and the Division of Emergency Medicine, Harvard Medical School, Boston, MA.
Department of Emergency Medicine, University of California-Davis, Sacramento, CA.
Ann Emerg Med. 2015 Apr;65(4):363-370.e1. doi: 10.1016/j.annemergmed.2014.10.036. Epub 2014 Dec 20.
We describe the operators, techniques, success, and adverse event rates of adult emergency department (ED) intubation through multicenter prospective surveillance.
Eighteen EDs in the United States, Canada, and Australia recorded intubation data onto a Web-based data collection tool, with a greater than or equal to 90% reporting compliance requirement. We report proportions with binomial 95% confidence intervals (CIs) and regression, with year as the dependent variable, to model change over time.
Of 18 participating centers, 5 were excluded for failing to meet compliance standards. From the remaining 13 centers, we report data on 17,583 emergency intubations of patients aged 15 years or older from 2002 to 2012. Indications were medical in 65% of patients and trauma in 31%. Rapid sequence intubation was the first method attempted in 85% of encounters. Emergency physicians managed 95% of intubations and most (79%) were physician trainees. Direct laryngoscopy was used in 84% of first attempts. Video laryngoscopy use increased from less than 1% in the first 3 years to 27% in the last 3 years (risk difference 27%; 95% CI 25% to 28%; mean odds ratio increase per year [ie, slope] 1.7; 95% CI 1.6 to 1.8). Etomidate was used in 91% and succinylcholine in 75% of rapid sequence intubations. Among rapid sequence intubations, rocuronium use increased from 8.2% in the first 3 years to 42% in the last 3 years (mean odds ratio increase per year 1.3; 95% CI 1.3 to 1.3). The first-attempt intubation success rate was 83% (95% CI 83% to 84%) and was higher in the last 3 years than in the first 3 (86% versus 80%; risk difference 6.2%; 95% CI 4.2% to 7.8%). The airway was successfully secured in 99.4% of encounters (95% CI 99.3% to 99.6%).
In the EDs we studied, emergency intubation has a high and increasing success rate. Both drug and device selection evolved significantly during the study period.
我们通过多中心前瞻性监测描述成人急诊科插管的操作人员、技术、成功率及不良事件发生率。
美国、加拿大和澳大利亚的18家急诊科将插管数据记录到一个基于网络的数据收集工具上，报告合规率需大于或等于90%。我们用二项式95%置信区间（CI）和回归分析报告比例，并以年份为因变量来模拟随时间的变化。
18个参与中心中，5个因未达合规标准被排除。从其余13个中心，我们报告了2002年至2012年15岁及以上患者17583例急诊插管的数据。65%患者的插管指征为内科疾病，31%为创伤。85%的插管尝试中首先采用快速顺序诱导插管法。急诊医生管理了95%的插管操作，且大多数（79%）是医生实习生。84%的首次尝试采用直接喉镜检查。可视喉镜的使用从最初3年的不到1%增加到最后3年的27%（风险差异27%；95%CI 25%至28%；每年平均优势比增加[即斜率]1.7；95%CI 1.6至1.8）。91%的快速顺序诱导插管使用依托咪酯，75%使用琥珀酰胆碱。在快速顺序诱导插管中，罗库溴铵的使用从最初3年的8.2%增加到最后3年的42%（每年平均优势比增加1.3；95%CI 1.3至1.3）。首次插管成功率为83%（95%CI 83%至84%），最后3年高于最初3年（86%对80%；风险差异6.2%；95%CI 4.2%至7.8%）。99.4%的插管操作成功确保了气道安全（95%CI 99.3%至99.6%）。
在我们研究的急诊科中，急诊插管成功率高且呈上升趋势。在研究期间，药物和设备的选择都有显著变化。
