Shapey I M, Kumar D S, Roberts K
University Hospitals Coventry and Warwickshire, Coventry, West Midlands, UK.
Warwickshire and Northamptonshire Air Ambulance (WNAA), Princethorpe, Warwickshire, UK.
Eur J Trauma Emerg Surg. 2012 Dec;38(6):633-9. doi: 10.1007/s00068-012-0207-9. Epub 2012 Jul 13.
On occasion, advanced invasive procedures in pre-hospital care can be life saving. This study aimed to identify the contemporary use of these procedures on a regional doctor-led air ambulance unit, and to define the need, skill set and training requirements for a regional pre-hospital team in the UK.
Mission data were recorded prospectively and the database reviewed to identify invasive procedures over a 76-month period. These cases were reviewed with indications, mechanism of injury, presence of cardiac arrest at any time point (±return of spontaneous circulation) and procedural failure or morbidity.
Two hundred and thirty-five procedures were performed: 16 for injuries affecting the airway, 111 for breathing and 108 for circulation. Almost a third of patients in cardiac arrest regained spontaneous circulation. Procedures performed increased fivefold from 2003 to 2009, with a marked increase in the use of thoracostomy and intra-osseous access. Procedural failure or inadequacy was high with needle cricothyroidotomy, needle chest decompression and early intra-osseous access experience.
A steady increase in the number of procedures was observed over time. Less invasive methods of airway and breathing support were frequently inadequate, though definitive surgical airway or chest decompression was effective each time it was performed. Thoracotomy was performed infrequently. There are implications for the training of pre-hospital doctors who work in the majority of the UK.
有时，院前急救中的高级侵入性操作可挽救生命。本研究旨在确定在一个由医生主导的区域空中救护单位中这些操作的当代使用情况，并明确英国区域院前团队的需求、技能组合和培训要求。
前瞻性记录任务数据，并审查数据库以确定76个月期间的侵入性操作。对这些病例进行审查，包括适应证、损伤机制、任何时间点心脏骤停的情况（±自主循环恢复）以及操作失败或并发症。
共进行了235次操作：16次针对气道损伤，111次针对呼吸，108次针对循环。近三分之一心脏骤停患者恢复了自主循环。从2003年到2009年，操作次数增加了五倍，胸廓切开术和骨内通路的使用显著增加。在环甲膜穿刺切开术、针胸减压术和早期骨内通路操作中，操作失败或不充分的情况较多。
随着时间的推移，观察到操作次数稳步增加。侵入性较小的气道和呼吸支持方法常常不足，不过每次进行确定性手术气道或胸腔减压时都是有效的。胸廓切开术实施较少。这对在英国大部分地区工作的院前医生的培训具有启示意义。
