Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin County, Taiwan.
Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Ann Emerg Med. 2018 Mar;71(3):387-396.e2. doi: 10.1016/j.annemergmed.2017.08.008. Epub 2017 Sep 28.
The effect of out-of-hospital intubation in patients with out-of-hospital cardiac arrest remains controversial. The Taipei City paramedics are the earliest authorized to perform out-of-hospital intubation among Asian areas. This study evaluates the association between successful intubation and out-of-hospital cardiac arrest survival in Taipei.
We analyzed 6 years of Utstein-based registry data from nontrauma adult patients with out-of-hospital cardiac arrest who underwent out-of-hospital airway management including intubation, laryngeal mask airway, or bag-valve-mask ventilation. The primary analysis was intubation success on patient outcomes. The primary outcome was survival to discharge and the secondary outcomes included sustained return of spontaneous circulation and favorable neurologic survival. Sensitivity analysis was performed with intubation attempts rather than intubation success. Subgroup analysis of advanced life support-serviced districts was also performed.
A total of 10,853 cases from 2008 to 2013 were analyzed. Among out-of-hospital cardiac arrest patients receiving airway management, successful intubation, laryngeal mask airway, and bag-valve-mask ventilation was reported in 1,541, 3,099, and 6,213 cases, respectively. Compared with bag-valve-mask device use, successful out-of-hospital intubation was associated with improved chances of sustained return of spontaneous circulation (adjusted odds ratio [aOR] 1.91; 95% confidence interval [CI] 1.66 to 2.19), survival to discharge (aOR 1.98; 95% CI 1.57 to 2.49), and favorable neurologic outcome (aOR 1.44; 95% CI 1.03 to 2.03). The results were comparable in sensitivity and subgroup analyses.
In nontrauma adult out-of-hospital cardiac arrest in Taipei, successful out-of-hospital intubation was associated with improved odds of sustained return of spontaneous circulation, survival to discharge, and favorable neurologic outcome.
院外心脏骤停患者的院外插管效果仍存在争议。台北市急救人员是亚洲最早获准进行院外插管的人员。本研究评估了台北市成功插管与院外心脏骤停存活之间的关系。
我们分析了 6 年基于 Utstein 的登记数据，这些数据来自接受院外气道管理（包括插管、喉罩气道或球囊-面罩通气）的非创伤性成年院外心脏骤停患者。主要分析是插管成功与患者结局的关系。主要结局是出院时存活，次要结局包括持续自主循环恢复和良好的神经功能存活。进行了敏感性分析，即使用插管尝试而不是插管成功。还进行了高级生命支持服务区的亚组分析。
共分析了 2008 年至 2013 年的 10853 例病例。在接受气道管理的院外心脏骤停患者中，成功插管、喉罩气道和球囊-面罩通气的比例分别为 1541 例、3099 例和 6213 例。与球囊-面罩通气装置的使用相比，成功的院外插管与持续自主循环恢复的机会增加相关（调整后的优势比 [aOR] 1.91；95%置信区间 [CI] 1.66 至 2.19），出院时存活（aOR 1.98；95% CI 1.57 至 2.49）和良好的神经功能结局（aOR 1.44；95% CI 1.03 至 2.03）。敏感性分析和亚组分析的结果相当。
在台北市非创伤性成年院外心脏骤停中，成功的院外插管与持续自主循环恢复、出院存活和良好的神经功能结局的机会增加相关。
