多次插管尝试失败与急诊科首次抢救插管成功率降低相关：多中心观察性数据的回顾性分析
Multiple failed intubation attempts are associated with decreased success rates on the first rescue intubation in the emergency department: a retrospective analysis of multicentre observational data.
作者信息
Goto Tadahiro, Gibo Koichiro, Hagiwara Yusuke, Morita Hiroshi, Brown David F M, Brown Calvin A, Hasegawa Kohei
出版信息
Scand J Trauma Resusc Emerg Med. 2015 Jan 16;23:5. doi: 10.1186/s13049-014-0085-8.
BACKGROUND
Although the international guidelines emphasize early and systematic use of rescue intubation techniques, there is little evidence to support this notion. We aimed to test the hypothesis that preceding multiple failed intubation attempts are associated with a decreased success rate on the first rescue intubation in emergency departments (EDs).
METHODS
We analysed data from two multicentre prospective registries designed to characterize current ED airway management in Japan between April 2010 and June 2013. All patients who underwent a rescue intubation after a failed attempt or a series of failed attempts were included for the analysis. Multiple failed intubation attempts were defined as ≥2 consecutive failed intubation attempts before a rescue intubation. Primary outcome measure was success rate on the first rescue intubation attempt.
RESULTS
Of 6,273 consecutive patients, 1,151 underwent a rescue intubation. The success rate on the first rescue intubation attempt declined as the number of preceding failed intubation attempts increased (81% [95% CI, 79%-84%] after one failed attempt; 71% [95% CI, 66%-76%] after two failed attempts; 67% [95% CI, 55%-78%] after three or more failed attempts; P(trend) <0.001). In the multivariable analysis adjusting for age, sex, principal indication, change in methods, devices, and intubator specialty, and clustering of patients within EDs, success rate on the first rescue intubation after two failed attempts was significantly lower (OR, 0.56; 95% CI, 0.41-0.77) compared to that after one failed attempt. Similarly, success rate on the first rescue intubation attempt after three or more failed attempts was significantly lower (OR, 0.49; 95% CI, 0.25-0.94) compared to that after one failed attempt.
CONCLUSION
Preceding multiple failed intubation attempts was independently associated with a decreased success rate on the first rescue intubation in the ED.
背景
尽管国际指南强调应尽早且系统地使用挽救性插管技术，但几乎没有证据支持这一观点。我们旨在验证这一假设，即在急诊科（ED），多次插管尝试失败与首次挽救性插管成功率降低相关。
方法
我们分析了两个多中心前瞻性登记处的数据，这些数据旨在描述2010年4月至2013年6月期间日本当前急诊科气道管理的情况。所有在一次或一系列插管尝试失败后接受挽救性插管的患者均纳入分析。多次插管尝试失败定义为在挽救性插管前连续≥2次插管尝试失败。主要结局指标是首次挽救性插管尝试的成功率。
结果
在6273例连续患者中，1151例接受了挽救性插管。首次挽救性插管尝试的成功率随着之前插管尝试失败次数的增加而下降（一次失败尝试后为81%[95%CI，79%-84%]；两次失败尝试后为71%[95%CI，66%-76%]；三次或更多次失败尝试后为67%[95%CI，55%-78%]；P（趋势）<0.001）。在对年龄、性别、主要适应证、方法、设备和插管医生专业的变化以及急诊科内患者聚集情况进行校正的多变量分析中，两次失败尝试后首次挽救性插管的成功率显著低于一次失败尝试后（OR，0.56；95%CI， 0.41-0.77）。同样，三次或更多次失败尝试后首次挽救性插管尝试的成功率显著低于一次失败尝试后（OR，0.49；95%CI，0.25-0.94）。
结论
之前多次插管尝试失败与急诊科首次挽救性插管成功率降低独立相关。
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