Immediate Health Associates, Westerville, Ohio.
The Ohio State University, Department of Emergency Medicine, Columbus, Ohio.
West J Emerg Med. 2018 Jul;19(4):660-667. doi: 10.5811/westjem.2018.4.37227. Epub 2018 May 15.
Emergency endotracheal intubation (ETI) is a common and critical procedure performed in both prehospital and in-hospital settings. Studies of prehospital providers have demonstrated that rescuer position influences ETI outcomes. However, studies of in-hospital rescuer position for ETI are limited. While we adhere to strict standards for the administration of ETI, we posited that perhaps requiring in-hospital rescuers to stand for ETI is an obstacle to effectiveness. Our objective was to compare in-hospital emergency medicine (EM) trainees' performance on ETI delivered from both the seated and standing positions.
EM residents performed ETI on a difficult airway mannequin from both a seated and standing position. They were randomized to the position from which they performed ETI first. All ETIs were recorded and then scored using a modified version of the Airway Management Proficiency Checklist. Residents also rated the laryngeal view and the difficulty of the procedure. We analyzed comparisons between ETI positions with paired t-tests.
Forty-two of our 49 residents (85.7%) participated. Fifteen (35.7%) were female, and all three levels of training were represented. The average number of prior ETI experiences among our subjects was 44 (standard deviation=34). All scores related to ETI performance were statistically equivalent across the two positions (performance score, number of attempts, time to intubation success, and ratings of difficulty and laryngeal view). We also observed no differences across levels of training.
The position of the in-hospital provider, whether seated or standing, had no effect on the provider's ETI performance. Since environmental circumstances sometimes necessitate alternative positioning for effective ETI administration, our findings suggest that there may be value in training residents to perform ETI from both positions.
紧急气管插管（ETI）是在院前和院内环境中都经常进行的一项关键操作。针对院前医护人员的研究表明，救援者的位置会影响 ETI 的结果。然而，有关院内救援者进行 ETI 时的位置的研究有限。尽管我们在 ETI 的实施方面遵循严格的标准，但我们假设，让院内救援者站立进行 ETI 可能会成为提高效果的障碍。我们的目的是比较在院的急诊医学（EM）住院医师在坐姿和站姿下进行 ETI 的表现。
EM 住院医师在困难气道模型上分别从坐姿和站姿进行 ETI。他们被随机分配首先从哪个位置进行 ETI。所有 ETI 均被记录下来，并使用改良的气道管理熟练检查表进行评分。住院医师还对声门视图和操作难度进行了评分。我们使用配对 t 检验分析 ETI 位置之间的比较。
我们的 49 名住院医师中有 42 名（85.7%）参与了研究。其中 15 名（35.7%）为女性，涵盖了所有三个培训水平。研究对象平均进行过 44 次（标准差=34）ETI 操作。在两种位置下，所有与 ETI 表现相关的评分都具有统计学等效性（操作评分、尝试次数、插管成功时间以及难度和声门视图的评分）。我们还观察到不同培训水平之间没有差异。
院内医护人员的位置（坐姿或站姿）对其 ETI 表现没有影响。由于环境情况有时需要采取替代的体位以有效进行 ETI 管理，我们的发现表明，对住院医师进行从两种体位进行 ETI 的培训可能具有价值。
