Pediatric Emergency Department, Rambam Health Care Campus, Haifa.
Israel Defense Forces Medical Corps, Ramat Gan.
Eur J Emerg Med. 2018 Oct;25(5):368-371. doi: 10.1097/MEJ.0000000000000480.
Advanced airway management of combat casualties during scene-to-hospital air transport is challenging. Because of the short transport time, flight physicians of the Israeli military airborne combat evacuation unit are approved for the use of a laryngeal mask airway (LMA) in the event of failed endotracheal intubation (ETI). The aim of this study was to assess the effectiveness of LMA use during scene-to-hospital transport of combat casualties in Israel.
A retrospective cohort analysis of all combat casualties treated with ETI during scene-to-hospital transport over a 3-year period was carried out. Successful LMA insertion was defined as satisfactory placement of the device on the basis of adequate chest expansion with bag-mask ventilation.
The median flight time from scene to hospital was 13 min [interquartile range (IQR): 9-15 min]. Sixty-five casualties underwent ETI attempts, 47 successful and 18 failed. All 18 casualties who had failed ETI underwent LMA insertion as a rescue treatment. Six casualties suffered from traumatic brain injury, six had firearm injuries, two had blast injuries, and two had inhalational injuries. LMA insertion was successful in 16/18 (88.9%) casualties, 14 survived to hospital discharge, whereas two were declared dead upon hospital arrival. Two cases of LMA insertion were unsuccessful, but patients survived to hospital discharge. Among the 16 successful cases, the median oxygen saturation on scene-pickup before LMA insertion and on hospital-handover with LMA in place were 90% (IQR: 84-96%) and 98% (IQR: 96-99%), respectively (P<0.0001, the 95% confidence interval for difference between medians was 4-11).
The findings of this study suggest that in the event of failed ETI, combat casualties can be treated effectively with LMA during a short scene-to-hospital transport time.
在从现场到医院的空中运输过程中，对战斗伤员进行高级气道管理具有挑战性。由于运输时间很短，以色列空军战斗伤员后送部队的飞行医生获准在经口气管插管（ETI）失败时使用喉罩气道（LMA）。本研究的目的是评估在以色列从现场到医院运输战斗伤员期间使用 LMA 的效果。
对 3 年内所有在从现场到医院的运输过程中接受 ETI 治疗的战斗伤员进行回顾性队列分析。成功插入 LMA 定义为根据充足的胸廓扩张和球囊面罩通气，装置放置满意。
从现场到医院的飞行时间中位数为 13 分钟[四分位间距（IQR）：9-15 分钟]。65 名伤员接受了 ETI 尝试，47 次成功，18 次失败。所有 18 名 ETI 失败的伤员均接受了 LMA 插入作为抢救治疗。6 名伤员患有创伤性脑损伤，6 名有火器伤，2 名有爆炸伤，2 名有吸入性损伤。LMA 插入在 16/18（88.9%）名伤员中成功，14 名存活至出院，2 名在到达医院时宣布死亡。LMA 插入有 2 例不成功，但患者存活至出院。在 16 例成功病例中，LMA 插入前现场接机时和插入后医院交接时的中位氧饱和度分别为 90%（IQR：84-96%）和 98%（IQR：96-99%）（P<0.0001，中位数差值的 95%置信区间为 4-11）。
本研究结果表明，在 ETI 失败的情况下，在从现场到医院的短时间运输过程中，可使用 LMA 对战斗伤员进行有效治疗。
