基于医师的院前急救经口气管插管的视频喉镜：使用 A.P. Advance、C-MAC 系统和 KingVision 对不同叶片类型的前瞻性、随机、多中心比较。

Videolaryngoscopy for Physician-Based, Prehospital Emergency Intubation: A Prospective, Randomized, Multicenter Comparison of Different Blade Types Using A.P. Advance, C-MAC System, and KingVision.

机构信息

From the Faculty of Medicine, Christian-Albrechts-University, Kiel, Germany.

Department of Anesthesiology, Anästhesie-Partner Holstein, MARE Clinics Kiel, Kiel, Germany.

出版信息

Anesth Analg. 2018 May;126(5):1565-1574. doi: 10.1213/ANE.0000000000002735.

DOI:10.1213/ANE.0000000000002735

PMID:29239965

Abstract

BACKGROUND

Videolaryngoscopy is a valuable technique for endotracheal intubation. When used in the perioperative period, different videolaryngoscopes vary both in terms of technical use and intubation success rates. However, in the prehospital environment, the relative performance of different videolaryngoscopic systems is less well studied.

METHODS

We conducted this prospective, randomized, multicenter study at 4 German prehospital emergency medicine centers. One hundred sixty-eight adult patients requiring prehospital emergency intubation were treated by an emergency physician and randomized to 1 of 3 portable videolaryngoscopes (A.P. Advance, C-MAC PM, and channeled blade KingVision) with different blade types. The primary outcome variable was overall intubation success and secondary outcomes included first-attempt intubation success, glottis visualization, and difficulty with handling the devices. P values for pairwise comparisons are corrected by the Bonferroni method for 3 tests (P[BF]). All presented P values are adjusted for center.

RESULTS

Glottis visualization was comparable with all 3 devices. Overall intubation success for A.P. Advance, C-MAC, and KingVision was 96%, 97%, and 61%, respectively (overall: P < .001, A.P. Advance versus C-MAC: odds ratio [OR], 0.97, 95% confidence interval [CI], 0.13-7.42, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001; C-MAC versus KingVision: OR, 0.043, 95% CI, 0.0088-0.21, P[BF] < 0.001). Intubation success on the first attempt with A.P. Advance, C-MAC, and KingVision was 86%, 85%, and 48%, respectively (overall: P < .001, A.P. Advance versus C-MAC: OR, 0.89, 95% CI, 0.31-2.53, P[BF] > 0.99; A.P. Advance versus KingVision: OR, 0.24, 95% CI, 0.055-0.38, P[BF] = 0.0054; C-MAC versus KingVision: OR, 0.21, 95% CI, 0.043-.34, P[BF] < 0.003). Direct laryngoscopy for successful intubation with the videolaryngoscopic device was necessary with the A.P. Advance in 5 patients, and with the C-MAC in 4 patients. In the KingVision group, 21 patients were intubated with an alternative device.

CONCLUSIONS

During prehospital emergency endotracheal intubation performed by emergency physicians, success rates of 3 commercially available videolaryngoscopes A.P. Advance, C-MAC PM, and KingVision varied markedly. We also found that although any of the videolaryngoscopes provided an adequate view, actual intubation was more difficult with the channeled blade KingVision.

摘要

背景

视频喉镜是一种用于气管插管的有价值的技术。在围手术期使用时，不同的视频喉镜在技术使用和插管成功率方面有所不同。然而，在院前环境中，不同视频喉镜系统的相对性能研究较少。

方法

我们在德国 4 个院前急救医学中心进行了这项前瞻性、随机、多中心研究。168 名需要院前紧急插管的成年患者由急诊医生治疗，并随机分为 3 组（A.P. Advance、C-MAC PM 和 KingVision），每组使用不同类型的叶片。主要结局变量为总体插管成功率，次要结局变量包括首次尝试插管成功率、声门可视化和设备使用难度。配对比较的 P 值通过 Bonferroni 方法校正了 3 次测试（P[BF]）。所有呈现的 P 值均针对中心进行了调整。

结果

所有 3 种设备的声门可视化效果相当。A.P. Advance、C-MAC 和 KingVision 的总体插管成功率分别为 96%、97%和 61%（总体：P<0.001，A.P. Advance 与 C-MAC：比值比[OR]，0.97，95%置信区间[CI]，0.13-7.42，P[BF]>0.99；A.P. Advance 与 KingVision：OR，0.043，95%CI，0.0088-0.21，P[BF]<0.001；C-MAC 与 KingVision：OR，0.043，95%CI，0.0088-0.21，P[BF]<0.001）。A.P. Advance、C-MAC 和 KingVision 的首次尝试插管成功率分别为 86%、85%和 48%（总体：P<0.001，A.P. Advance 与 C-MAC：OR，0.89，95%CI，0.31-2.53，P[BF]>0.99；A.P. Advance 与 KingVision：OR，0.24，95%CI，0.055-0.38，P[BF]=0.0054；C-MAC 与 KingVision：OR，0.21，95%CI，0.043-0.34，P[BF]<0.003）。A.P. Advance 组中有 5 例患者需要直接喉镜才能成功插管，C-MAC 组中有 4 例患者需要直接喉镜才能成功插管。在 KingVision 组中，有 21 例患者使用替代设备进行插管。