Williamson County EMS, 3189 SE Inner Loop, Georgetown, TX 78626, United States; Baylor Scott & White Healthcare, Temple, TX 78683, United States.
ESO Solutions, 11500 Alterra Parkway, Suite 100, Austin, TX 78758, United States.
Resuscitation. 2018 Sep;130:57-60. doi: 10.1016/j.resuscitation.2018.07.002. Epub 2018 Jul 3.
We sought to characterize the number of attempts required to achieve advanced airway management (AAM) success.
Using 4 years of data from a national EMS electronic health record system, we examined the following subsets of attempted AAM: 1) cardiac arrest intubation (CA-ETI), 2) non-arrest medical intubation (MED-ETI), 3) non-arrest trauma intubation (TRA-ETI), 4) rapid-sequence intubation (RSI), 5) sedation-assisted ETI (SAI), and 6) supraglottic airway (SGA). We determined the first pass and overall success rates, as well as the point of additional attempt futility ("plateau point").
Among 57,209 patients there were 64,291 AAM. CA-ETI performance was: first-pass success (FPS) 71.4% (95% CI: 70.9-71.9%), 4 attempts to reach 91.5% (91.2-91.9%) success plateau. MED-ETI performance was: FPS 66.0% (95% CI: 65.1-67.0%), 3 attempts to reach 79.2% (78.4-80.0%) success plateau. TRA-ETI performance was: FPS 61.6% (95% CI: 59.3-63.9%), 3 attempts to reach 75.8% (73.7-77.8%) success plateau. RSI performance was: FPS 76.1% (95% CI: 75.1-77.1%), 5 attempts to reach 95.8% (95.3-96.2%) success plateau. SAI performance was: FPS 66.9% (95% CI: 65.1-68.6%), 3 attempts to 85.3% (83.9-86.6%) success plateau. SGA performance was: FPS 88.7% (95% CI: 88.0-89.3%), 5 attempts to reach 92.8% (92.3-93.4%) success plateau.
Multiple attempts are often needed to accomplish successful AAM. The number of attempts needed to accomplish AAM varies with AAM technique. These results may guide AAM practices.
本研究旨在描述实现高级气道管理（AAM）成功所需的尝试次数。
利用全国急救医疗服务（EMS）电子健康记录系统 4 年的数据，我们检查了以下尝试 AAM 的子集：1）心脏骤停插管（CA-ETI），2）非心脏骤停的医学插管（MED-ETI），3）非创伤性插管（TRA-ETI），4）快速序贯插管（RSI），5）镇静辅助插管（SAI）和 6）声门上气道（SGA）。我们确定了首次尝试和总体成功率，以及额外尝试无效的临界点（“平台点”）。
在 57209 例患者中，有 64291 例 AAM。CA-ETI 的表现为：首次尝试成功率（FPS）为 71.4%（95%CI：70.9-71.9%），达到 91.5%（91.2-91.9%）成功率平台需要 4 次尝试。MED-ETI 的表现为：FPS 为 66.0%（95%CI：65.1-67.0%），达到 79.2%（78.4-80.0%）成功率平台需要 3 次尝试。TRA-ETI 的表现为：FPS 为 61.6%（95%CI：59.3-63.9%），达到 75.8%（73.7-77.8%）成功率平台需要 3 次尝试。RSI 的表现为：FPS 为 76.1%（95%CI：75.1-77.1%），达到 95.8%（95.3-96.2%）成功率平台需要 5 次尝试。SAI 的表现为：FPS 为 66.9%（95%CI：65.1-68.6%），达到 85.3%（83.9-86.6%）成功率平台需要 3 次尝试。SGA 的表现为：FPS 为 88.7%（95%CI：88.0-89.3%），达到 92.8%（92.3-93.4%）成功率平台需要 5 次尝试。
多次尝试通常是成功实现 AAM 所必需的。完成 AAM 所需的尝试次数因 AAM 技术而异。这些结果可能为 AAM 实践提供指导。
