Van Oeveren Lucas, Donner Julie, Fantegrossi Andrea, Mohr Nicholas M, Brown Calvin A
1 Section of Emergency Medicine, Avera McKennan Hospital , Sioux Falls, South Dakota.
2 Avera eCARE, Avera Health System , Sioux Falls, South Dakota.
Telemed J E Health. 2017 Apr;23(4):290-297. doi: 10.1089/tmj.2016.0140. Epub 2016 Sep 27.
Intubation in rural emergency departments (EDs) is a high-risk procedure, often with little or no specialty support. Rural EDs are utilizing real-time telemedicine links, connecting providers to an ED physician who may provide clinical guidance.
We endeavored to describe telemedicine-assisted intubation in rural EDs that are served by an ED telemedicine network.
Prospective data were collected on all patients who had an intubation attempt while on the video telemedicine link from May 1, 2014 to April 30, 2015. We report demographic information, indication, methods, number of attempts, operator characteristics, telemedicine involvement/intervention, adverse events, and clinical outcome by using descriptive statistics.
Included were 206 intubations. The most common indication for intubation was respiratory failure. First-pass success rate (postactivation) was 71%, and 96% were eventually intubated. Most attempts (66%) used rapid-sequence intubation. Fifty-four percent of first attempts used video laryngoscopy (VL). Telemedicine providers intervened in 24%, 43%, and 55% of first-third attempts, respectively. First-pass success with VL and direct laryngoscopy was equivalent (70% vs. 71%, p = 0.802). Adverse events were reported in 49 cases (24%), which were most frequently hypoxemia.
The impact of telemedicine during emergency intubation is not defined. We showed a 71% first-pass rate post-telemedicine linkage (70% of cases had a previous attempt). Our ultimate success rate was 96%, similar to that in large-center studies. Telemedicine support may contribute to success.
Telemedicine-supported endotracheal intubation performed in rural hospitals is feasible, with good success rates. Future research is required to better define the impact of telemedicine providers on emergency airway management.
农村急诊科的插管操作是一项高风险程序，通常很少或根本没有专科支持。农村急诊科正在利用实时远程医疗链接，将医护人员与可能提供临床指导的急诊科医生相连。
我们试图描述由急诊科远程医疗网络服务的农村急诊科中远程医疗辅助插管的情况。
收集了2014年5月1日至2015年4月30日期间在视频远程医疗链接上进行插管尝试的所有患者的前瞻性数据。我们使用描述性统计报告人口统计学信息、插管指征、方法、尝试次数、操作者特征、远程医疗参与/干预情况、不良事件和临床结果。
共纳入206例插管操作。最常见的插管指征是呼吸衰竭。首次通过成功率（激活后）为71%，最终插管成功率为96%。大多数尝试（66%）采用快速顺序插管。首次尝试中有54%使用了视频喉镜（VL）。远程医疗提供者分别在首次至第三次尝试的24%、43%和55%中进行了干预。VL和直接喉镜检查的首次通过成功率相当（70%对71%，p = 0.802）。报告了49例（24%）不良事件，最常见的是低氧血症。
远程医疗在紧急插管过程中的影响尚不明确。我们显示远程医疗链接后的首次通过成功率为71%（70%的病例之前有过尝试）。我们的最终成功率为96%，与大型中心研究的结果相似。远程医疗支持可能有助于取得成功。
在农村医院进行的远程医疗支持下的气管插管是可行的，成功率较高。需要进一步研究以更好地确定远程医疗提供者对紧急气道管理的影响。
