Tweed Jefferson, George Taylor, Greenwell Cynthia, Vinson Lori
1Trauma Services,Children's Health,Dallas,TexasUSA.
Prehosp Disaster Med. 2018 Oct;33(5):532-538. doi: 10.1017/S1049023X18000882.
IntroductionRoutine advanced airway usage by Emergency Medical Services (EMS) has had conflicting reports of being the secure airway of choice in pediatric patients.Hypothesis/ProblemThe primary objective was to describe a pediatric cohort requiring airway management upon their arrival directly from the scene to two pediatric emergency departments (PEDs). A secondary objective included assessing for associations in EMS airway management and patient outcomes.
Retrospective data from the health record were reviewed, including EMS reports, for all arrivals less than 18 years old to two PEDs who required airway support between May 2015 and July 2016. The EMS management was classified as basic (oxygen, continuous positive airway pressure [CPAP], or bag-valve-mask [BVM]) or advanced (supraglottic or endotracheal intubation [ETI]) based on EMS documentation. Outcomes included oxygenation as documented by receiving PED and hospital mortality.
In total, 104 patients with an average age 5.9 (SD=5.1) years and median EMS Glasgow Coma Scale (GCS) of nine (IQR 3-14) were enrolled. Basic management was utilized in 70% of patients (passive: n=49; CPAP: n=2; BVM: n=22). Advanced management was utilized in 30% of patients (supraglottic: n=4; ETI: n=27). Proper ETI placement was achieved in 48% of attempted patients, with 41% of patients undergoing multiple attempts. Inadequate oxygenation occurred in 18% of patients, including four percent of ETI attempts, nine percent of BVM patients, and 32% of passively managed patients. Adjusted for EMS GCS, medical patients undergoing advanced airway management experienced higher risk of mortality (risk-ratio [RR] 2.98; 95% CI, 1.18-7.56; P=.021).
With exception to instances where ETI is clearly indicated, BVM management is effective in pediatric patients who required airway support, with ETI providing no definitive protective factors. Most of the patients who exhibited inadequate oxygenation upon arrival to the PED received only passive oxygenation by EMS. TweedJ, GeorgeT, GreenwellC, VinsonL. Prehospital airway management examined at two pediatric emergency centers. Prehosp Disaster Med. 2018;33(5):532-538.
引言
紧急医疗服务（EMS）常规使用高级气道在儿科患者中是否为首选安全气道存在相互矛盾的报道。
假设/问题
主要目的是描述一组直接从现场转运至两家儿科急诊科（PED）后需要气道管理的儿科患者。次要目的包括评估EMS气道管理与患者结局之间的关联。
回顾了2015年5月至2016年7月期间所有年龄小于18岁、需要气道支持且转运至两家PED的患者的健康记录中的回顾性数据，包括EMS报告。根据EMS记录，将EMS管理分类为基础管理（吸氧、持续气道正压通气[CPAP]或面罩球囊通气[BVM]）或高级管理（声门上气道或气管插管[ETI]）。结局包括PED记录的氧合情况和医院死亡率。
共纳入104例患者，平均年龄5.9（标准差=5.1）岁，EMS格拉斯哥昏迷量表（GCS）中位数为9（四分位间距3 - 14）。70%的患者采用基础管理（被动吸氧：n = 49；CPAP：n = 2；BVM：n = 22）。30%的患者采用高级管理（声门上气道：n = 4；ETI：n = 27）。48%的尝试ETI插管的患者插管成功，41%的患者进行了多次尝试。18%的患者存在氧合不足，包括4%的ETI尝试患者、9%的BVM患者和32%的被动管理患者。校正EMS GCS后，接受高级气道管理的内科患者死亡风险更高（风险比[RR] 2.98；95%置信区间，1.18 - 7.56；P = 0.021）。
除了明确需要ETI的情况外，BVM管理对需要气道支持的儿科患者有效，ETI未提供明确的保护因素。大多数到达PED时表现出氧合不足的患者在EMS阶段仅接受了被动吸氧。
特威德J、乔治T、格林韦尔C、文森L。两家儿科急诊中心的院前气道管理研究。院前急救与灾难医学。2018；33(5):532 - 538。
