Wimalasena Yashvi, Burns Brian, Reid Cliff, Ware Sandra, Habig Karel
Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Emergency Department, Royal North Shore Hospital, Sydney, Sydney, NSW, Australia.
Greater Sydney Area Helicopter Emergency Medical Service NSW Ambulance Service, Sydney, NSW, Australia; Discipline of Emergency Medicine, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Ann Emerg Med. 2015 Apr;65(4):371-6. doi: 10.1016/j.annemergmed.2014.11.014. Epub 2014 Dec 20.
The Greater Sydney Area Helicopter Emergency Medical Service undertakes in excess of 2,500 physician/paramedic out-of-hospital and interhospital retrievals each year, of which 8% require intubation. Emergency anesthesia of critically ill patients is associated with complications, including hypoxia. In July 2011, the service introduced apneic oxygenation with nasal cannulae to its emergency anesthesia standard operating procedure to reduce rates of desaturation during rapid sequence intubation. We evaluate the association between the introduction of apneic oxygenation and incidence of desaturation during rapid sequence intubation in both out-of-hospital and interhospital retrievals.
This was a retrospective study of prospectively collected airway registry data. Consecutive patients who underwent rapid sequence intubation by Greater Sydney Area Helicopter Emergency Medical Service personnel between September 2009 and July 2013, spanning the introduction of apneic oxygenation, were included for analysis (n=728). We compared patients who underwent rapid sequence intubation before the service introduced apneic oxygenation (n=310) with those who underwent it after its introduction (n=418). We evaluated the association between the introduction of apneic oxygenation and the incidence of desaturation.
During the study period, 9,901 missions were conducted with 728 rapid sequence intubations (310 pre- and 418 postapneic oxygenation). The introduction of apneic oxygenation was followed by a decrease in desaturation rates from 22.6% to 16.5% (difference=6.1%; 95% confidence interval 0.2% to 11.2%).
Introduction of apneic oxygenation was associated with decreased incidence of desaturation in patients undergoing rapid sequence intubation.
大悉尼地区直升机紧急医疗服务每年进行超过2500次医生/护理人员的院外及院际转运，其中8%需要插管。危重症患者的急诊麻醉会引发包括缺氧在内的并发症。2011年7月，该服务将经鼻导管进行的无呼吸给氧纳入其急诊麻醉标准操作流程，以降低快速顺序诱导插管期间的血氧饱和度下降发生率。我们评估了无呼吸给氧的引入与院外及院际转运快速顺序诱导插管期间血氧饱和度下降发生率之间的关联。
这是一项对前瞻性收集的气道登记数据进行的回顾性研究。纳入了2009年9月至2013年7月期间大悉尼地区直升机紧急医疗服务人员进行快速顺序诱导插管的连续患者进行分析（n = 728），该时间段涵盖了无呼吸给氧的引入。我们将在该服务引入无呼吸给氧之前进行快速顺序诱导插管的患者（n = 310）与引入之后进行该操作的患者（n = 418）进行了比较。我们评估了无呼吸给氧的引入与血氧饱和度下降发生率之间的关联。
在研究期间，共执行了9901次任务，其中有728次快速顺序诱导插管（无呼吸给氧前310次，无呼吸给氧后418次）。引入无呼吸给氧后，血氧饱和度下降率从22.6%降至16.5%（差值 = 6.1%；95%置信区间0.2%至11.2%）。
引入无呼吸给氧与快速顺序诱导插管患者的血氧饱和度下降发生率降低相关。
