阿富汗地面部队对创伤患者进行的院前气道处理。

Prehospital airway procedures performed in trauma patients by ground forces in Afghanistan.

机构信息

From the Tactical Combat Casualty Care Research (M.B.B., K.L.R., S.G.S.), US Army Institute of Surgical Research; Department of Emergency Medicine (M.D.A., D.J.B.), San Antonio Uniformed Services Health Education Consortium, JBSA Fort Sam Houston; Department of Emergency Medicine (R.A.D.), University of Texas Health Science Center, San Antonio; and South Texas Diabetes Obesity Institute (A.N.B.), University of Rio Grande Valley, Brownsville, Texas.

出版信息

J Trauma Acute Care Surg. 2018 Jul;85(1S Suppl 2):S154-S160. doi: 10.1097/TA.0000000000001866.

DOI:10.1097/TA.0000000000001866

PMID:29521802

Abstract

BACKGROUND

Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4% to 7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield.

METHODS

This study is a retrospective review of casualties that required a prehospital lifesaving airway intervention during combat operations in Afghanistan. We obtained data from the Prehospital Trauma Registry that was linked to the Department of Defense Trauma Registry for outcome data for the time period between January 2013 and September 2014.

RESULTS

Seven hundred five total trauma patients were included, 16.9% required a prehospital airway management procedure. There were 132 total airway procedures performed, including 83 (63.4%) endotracheal intubations and 26 (19.8%) nasopharyngeal airway placements. Combat medics were involved in 48 (36.4%) of airway cases and medical officers in 73 (55.3%). Most (94.2%) patients underwent airway procedures due to battle injuries caused by explosion or gunshot wounds. Casualties requiring airway management were more severely injured and less likely to survive as indicated by Injury Severity Score, responsiveness level, Glascow Coma Scale, and outcome.

CONCLUSION

Percentages of airway interventions more than tripled from previous reports from the wars in Afghanistan and Iraq. These changes are significant, and further study is needed to determine the causes. Casualties requiring airway interventions sustained more severe injuries and experienced lower survival than patients who did not undergo an airway procedure, findings suggested in previous reports.

LEVEL OF EVIDENCE

Prognostic and epidemiological study, level III.

摘要

背景

气道管理在战创伤患者中至关重要。气道障碍是战场上第二大致命原因，约占可预防死亡人数的 10%。来自伊拉克和阿富汗战争的报告表明，在运往战斗医院的伤员中，有 4%至 7%需要进行气道干预。本研究的目的是描述战场前的气道管理情况，并记录战场上使用的气道设备。

方法

这是一项对阿富汗作战行动中需要院前救生气道干预的伤员的回顾性研究。我们从院前创伤登记处获取数据，并将其与国防部创伤登记处联系起来，以获取 2013 年 1 月至 2014 年 9 月期间的结果数据。

结果

共有 705 名创伤患者，16.9%需要院前气道管理程序。共进行了 132 次气道处理，包括 83 次（63.4%）气管插管和 26 次（19.8%）鼻咽气道放置。战斗医护人员参与了 48 例（36.4%）气道病例，医疗官参与了 73 例（55.3%）。大多数（94.2%）患者因爆炸或枪伤导致的战斗伤接受了气道处理。需要气道管理的伤员伤势更严重，生存率较低，这表明损伤严重程度评分、反应水平、格拉斯哥昏迷评分和结局都较差。