Fouche Pieter F, Stein Christopher, Simpson Paul, Carlson Jestin N, Zverinova Kristina M, Doi Suhail A
Prehosp Emerg Care. 2018 Sep-Oct;22(5):578-587. doi: 10.1080/10903127.2017.1423139. Epub 2018 Jan 29.
Endotracheal intubation (ETI) is a critical procedure performed by both air medical and ground based emergency medical services (EMS). Previous work has suggested that ETI success rates are greater for air medical providers. However, air medical providers may have greater airway experience, enhanced airway education, and access to alternative ETI options such as rapid sequence intubation (RSI). We sought to analyze the impact of the type of EMS on RSI success.
A systematic literature search of Medline, Embase, and the Cochrane Library was conducted and eligibility, data extraction, and assessment of risk of bias were assessed independently by two reviewers. A bias-adjusted meta-analysis using a quality-effects model was conducted for the primary outcomes of overall intubation success and first-pass intubation success.
Forty-nine studies were included in the meta-analysis. There was no difference in the overall success between flight and ground based EMS; 97% (95% CI 96-98) vs. 98% (95% CI 91-100), and no difference in first-pass success for flight compared to ground based RSI; 82% (95% CI 73-89) vs. 82% (95% CI 70-93). Compared to flight non-physicians, flight physicians have higher overall success 99% (95% CI 98-100) vs. 96% (95% CI 94-97) and first-pass success 89% (95% CI 77-98) vs. 71% (95% CI 57-84). Ground-based physicians and non-physicians have a similar overall success 98% (95% CI 88-100) vs. 98% (95% CI 95-100), but no analysis for physician ground first pass was possible.
Both overall and first-pass success of RSI did not differ between flight and road based EMS. Flight physicians have a higher overall and first-pass success compared to flight non-physicians and all ground based EMS, but no such differences are seen for ground EMS. Our results suggest that ground EMS can use RSI with similar outcomes compared to their flight counterparts.
气管插管（ETI）是空中医疗和地面紧急医疗服务（EMS）都要进行的关键操作。先前的研究表明，空中医疗服务提供者的ETI成功率更高。然而，空中医疗服务提供者可能有更丰富的气道管理经验、更好的气道相关培训，并且可以采用如快速顺序诱导插管（RSI）等其他ETI方法。我们试图分析EMS类型对RSI成功率的影响。
对Medline、Embase和Cochrane图书馆进行系统的文献检索，两名评审员独立评估纳入标准、数据提取和偏倚风险评估。采用质量效应模型进行偏倚调整的荟萃分析，以评估总体插管成功率和首次插管成功率等主要结局。
荟萃分析纳入了49项研究。空中和地面EMS在总体成功率上没有差异；分别为97%（95%CI 96 - 98）和98%（95%CI 91 - 100），在空中与地面RSI的首次插管成功率上也没有差异；分别为82%（95%CI 73 - 89）和82%（95%CI 70 - 93）。与空中非医生相比，空中医生的总体成功率更高，分别为99%（95%CI 98 - 100）和96%（95%CI 94 - 97），首次插管成功率分别为89%（95%CI 77 - 98）和71%（95%CI 57 - 84）。地面医生和非医生的总体成功率相似，分别为98%（95%CI 88 - 100）和98%（95%CI 95 - 100），但无法对地面医生的首次插管情况进行分析。
空中和地面EMS在RSI的总体成功率和首次插管成功率方面没有差异。与空中非医生和所有地面EMS相比，空中医生的总体成功率和首次插管成功率更高，但地面EMS之间未观察到此类差异。我们的结果表明，地面EMS使用RSI可获得与空中EMS相似的结果。
