Goto Yukari, Goto Tadahiro, Hagiwara Yusuke, Tsugawa Yusuke, Watase Hiroko, Okamoto Hiroshi, Hasegawa Kohei
Department of Emergency Medicine, Nagoya Ekisaikai Hospital, 4-66 Shonen, Nakagawa, Nagoya, Aichi 454-8502, Japan.
Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street Boston, Suite 920, Boston, MA 02114, USA.
Resuscitation. 2017 May;114:14-20. doi: 10.1016/j.resuscitation.2017.02.009. Epub 2017 Feb 17.
Continuous surveillance of emergency airway management practice is imperative in improving quality of care and patient safety. We aimed to investigate the changes in the practice of emergency airway management and the related outcomes in the emergency departments (EDs) in Japan.
We conducted an analysis of the data from two prospective, observational, multicentre registries of emergency airway management-the Japanese Emergency Airway Network (JEAN)-1 and -2 Registries from April 2010 through May 2016.
We recorded 10,927 ED intubations (capture rate, 96%); 10,875 paediatric and adult patients were eligible for our analysis. The rate of rapid sequence intubation (RSI) use as the initial intubation method significantly increased from 28% in 2010 to 53% in 2016 (P=0.03). Likewise, the rate of video laryngoscope (VL) use as the first intubation device increased significantly from 2% in 2010 to 40% in 2016 (P<0.001), with a significant decrease in the rate of direct laryngoscope use from 97% in 2010 to 58% in 2016 (P<0.001). Concurrent with these changes, the overall first-attempt success rate also increased from 68% in 2010 to 74% in 2016 (P=0.02). By contrast, the rate of adverse events did not change significantly over time (P=0.06).
By using data from two large, multicentre, prospective registries, we characterised the current emergency airway management practice, and identified their changes in Japan. The data demonstrated significant increases in the rate of RSI and VL use on the first attempt and the first-attempt success rate over the 6-year study period.
持续监测急诊气道管理实践对于提高医疗质量和患者安全至关重要。我们旨在调查日本急诊科（ED）急诊气道管理实践的变化及相关结果。
我们对两个前瞻性、观察性、多中心急诊气道管理注册研究——日本急诊气道网络（JEAN）-1和-2注册研究在2010年4月至2016年5月期间的数据进行了分析。
我们记录了10927例急诊插管（捕获率96%）；10875例儿科和成年患者符合我们的分析条件。作为初始插管方法的快速顺序诱导插管（RSI）使用率从2010年的28%显著增加到2016年的53%（P=0.03）。同样，作为首次插管设备的视频喉镜（VL）使用率从2010年的2%显著增加到2016年的40%（P<0.001），直接喉镜使用率从2010年的97%显著下降到2016年的58%（P<0.001）。与这些变化同时发生的是，总体首次尝试成功率也从2010年的68%增加到2016年的74%（P=0.02）。相比之下，不良事件发生率随时间没有显著变化（P=0.06）。
通过使用来自两个大型、多中心、前瞻性注册研究的数据，我们描述了当前的急诊气道管理实践，并确定了其在日本的变化。数据显示，在6年的研究期间，首次尝试时RSI和VL的使用率以及首次尝试成功率显著增加。
