Heschl Stefan, Meadley Ben, Andrew Emily, Butt Warwick, Bernard Stephen, Smith Karen
Medical University of Graz, Graz, Austria; Ambulance Victoria, Melbourne, Victoria, Australia.
Ambulance Victoria, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Injury. 2018 May;49(5):916-920. doi: 10.1016/j.injury.2018.02.013. Epub 2018 Feb 12.
Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation.
We conducted a retrospective study of patients aged ≤14 years with suspected TBI in Victoria, Australia. Patients were either transported via helicopter and received RSI by an ICP (2005-2013) or via road ambulance and received no intubation (2006-2013). Prehospital data was linked to hospital and 6-month follow-up data to assess mortality and functional outcome.
A total of 106 patients were included in the study of which 87 received RSI by paramedics and 19 did not receive intubation. Overall, the intubation success rate was 99% (86/87), with a first-pass success rate of 93% (81/87). In total, 67% of patients (n = 41) receiving RSI had a favourable functional outcome, compared with 54% of non-intubated patients (n = 7) (p = 0.36). In the 75 children with major trauma, prehospital RSI was associated with a significant decrease in length of hospital stay (523 h vs. 1939 h, p = 0.03). In the 53 children in this subgroup with available six months data the difference in favourable functional outcome increased to 66% (n = 31)vs. 17% (n = 1) (p = 0.06).
Prehospital RSI in paediatric patients with TBI can safely be performed by highly trained paramedics. Overall, we observed more favourable long-term outcomes in patients who received prehospital intubation than those who did not, however our study is not powered to detect a significant difference. Intubation prior to transport might be beneficial for major trauma patients.
创伤性脑损伤（TBI）患儿的院前气道管理存在争议。在现场对儿童进行气管插管需要特定技能，虽有潜在益处，但也可能带来严重并发症。我们旨在比较接受过重症护理医护人员（ICP）进行院前快速顺序插管（RSI）的TBI患儿与未插管患儿在六个月后的死亡率和功能结局。
我们对澳大利亚维多利亚州年龄≤14岁的疑似TBI患者进行了一项回顾性研究。患者要么通过直升机转运并由ICP进行RSI（2005 - 2013年），要么通过公路救护车转运且未进行插管（2006 - 2013年）。院前数据与医院及6个月随访数据相关联，以评估死亡率和功能结局。
共有106例患者纳入研究，其中87例接受了医护人员的RSI，19例未进行插管。总体而言，插管成功率为99%（86/87），首次通过成功率为93%（81/87）。接受RSI的患者中，总计67%（n = 41）功能结局良好，未插管患者为54%（n = 7）（p = 0.36）。在75例严重创伤患儿中，院前RSI与住院时间显著缩短相关（523小时对1939小时，p = 0.03）。在该亚组中有6个月可用数据的53例患儿中，功能结局良好的差异增至66%（n = 31）对17%（n = 1）（p = 0.06）。
经过高度培训的医护人员可安全地对TBI患儿进行院前RSI。总体而言，我们观察到接受院前插管的患者长期结局比未插管患者更有利，但我们的研究尚无足够能力检测出显著差异。转运前插管可能对严重创伤患者有益。
