Reichert Ryan J, Gothard Megan, Gothard M David, Schwartz Hamilton P, Bigham Michael T
Prehosp Emerg Care. 2018 Sep-Oct;22(5):571-577. doi: 10.1080/10903127.2017.1419324. Epub 2018 Feb 21.
Tracheal intubation (TI) is a lifesaving critical care skill. Failed TI attempts, however, can harm patients. Critical care transport (CCT) teams function as the first point of critical care contact for patients being transported to tertiary medical centers for specialized surgical, medical, and trauma care. The Ground and Air Medical qUality in Transport (GAMUT) Quality Improvement Collaborative uses a quality metric database to track CCT quality metric performance, including TI. We sought to describe TI among GAMUT participants with the hypothesis that CCT would perform better than other prehospital TI reports and similarly to hospital TI success.
The GAMUT Database is a global, voluntary database for tracking consensus quality metric performance among CCT programs performing neonatal, pediatric, and adult transports. The TI-specific quality metrics are "first attempt TI success" and "definitive airway sans hypoxia/hypotension on first attempt (DASH-1A)." The 2015 GAMUT Database was queried and analysis included patient age, program type, and intubation success rate. Analysis included simple statistics and Pearson chi-square with Bonferroni-adjusted post hoc z tests (significance = p < 0.05 via two-sided testing).
Overall, 85,704 patient contacts (neonatal n [%] = 12,664 [14.8%], pediatric n [%] = 28,992 [33.8%], adult n [%] = 44,048 [51.4%]) were included, with 4,036 (4.7%) TI attempts. First attempt TI success was lowest in neonates (59.3%, 617 attempts), better in pediatrics (81.7%, 519 attempts), and best in adults (87%, 2900 attempts), p < 0.001. Adult-focused CCT teams had higher overall first attempt TI success versus pediatric- and neonatal-focused teams (86.9% vs. 63.5%, p < 0.001) and also in pediatric first attempt TI success (86.5% vs. 75.3%, p < 0.001). DASH-1A rates were lower across all patient types (neonatal = 51.9%, pediatric = 74.3%, adult = 79.8%).
CCT TI is not uncommon, and rates of TI and DASH-1A success are higher in adult patients and adult-focused CCT teams. TI success rates are higher in CCT than other prehospital settings, but lower than in-hospital success TI rates. Identifying factors influencing TI success among high performers should influence best practice strategies for TI.
气管插管（TI）是一项挽救生命的重症监护技能。然而，气管插管尝试失败会对患者造成伤害。重症监护转运（CCT）团队是将患者转运至三级医疗中心接受专科手术、医疗和创伤护理时，患者接受重症监护的第一接触点。地面和空中医疗转运质量（GAMUT）质量改进协作组织使用一个质量指标数据库来跟踪CCT的质量指标表现，包括气管插管。我们试图描述GAMUT参与者中的气管插管情况，假设CCT的表现会优于其他院前气管插管报告，且与医院内气管插管成功率相似。
GAMUT数据库是一个全球性的自愿数据库，用于跟踪进行新生儿、儿科和成人转运的CCT项目之间的共识质量指标表现。特定于气管插管的质量指标是“首次尝试气管插管成功率”和“首次尝试时无缺氧/低血压的确定性气道（DASH - 1A）”。查询了2015年的GAMUT数据库，分析包括患者年龄、项目类型和插管成功率。分析包括简单统计以及采用Bonferroni校正的事后z检验的Pearson卡方检验（双侧检验，显著性 = p < 0.05）。
总体而言，纳入了85,704次患者接触（新生儿n[％] = 12,664[14.8％]，儿科n[％] = 28,992[33.8％]，成人n[％] = 44,048[51.4％]），其中有4,036次（4.7％）气管插管尝试。首次尝试气管插管成功率在新生儿中最低（59.3％，617次尝试），儿科中较好（81.7％，519次尝试），成人中最佳（87％，2900次尝试），p < 0.001。专注于成人的CCT团队总体首次尝试气管插管成功率高于专注于儿科和新生儿的团队（86.9％对63.5％，p < 0.001），在儿科首次尝试气管插管成功率方面也是如此（86.5％对75.3％，p < 0.001）。所有患者类型的DASH - 1A率都较低（新生儿 = 51.9％，儿科 = 74.3％，成人 = 79.8％）。
CCT中的气管插管并不罕见，成人患者和专注于成人的CCT团队的气管插管及DASH - 1A成功率更高。CCT中的气管插管成功率高于其他院前环境，但低于医院内气管插管成功率。确定高绩效者中影响气管插管成功的因素应能影响气管插管的最佳实践策略。
