Özkurtul Orkun, Struck Manuel F, Fakler Johannes, Bernhard Michael, Seinen Silja, Wrigge Hermann, Josten Christoph
Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany.
Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany.
Trauma Surg Acute Care Open. 2019 Feb 8;4(1):e000271. doi: 10.1136/tsaco-2018-000271. eCollection 2019.
Endotracheal intubation (ETI) is the gold standard for the out-of-hospital emergency airway management in severely injured patients. Due to time-critical circumstances, poor patient presentation and hostile environments, it may be prone for mechanical complications and failure.
In a retrospective study (January 2011 to December 2013), all patients who underwent out-of-hospital ETI before admittance to a level 1 trauma center were analyzed consecutively. Patients with supraglottic airways, being under cardiopulmonary resuscitation and interfacility transports were excluded. The main study endpoint was the incidence of unrecognized tube malposition; secondary endpoints were Glasgow Outcome Scale (GOS) and in-hospital mortality adjusted to on-scene Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Scale head (AIS head), and on-scene time.
Out of 1176 patients, 151 underwent out-of-hospital ETI. At hospital admission, tube malpositions were recognized in nine patients (5.9%). Accidental and unrecognized esophageal intubation was detected in five patients (3.3%) and bronchial intubation in four patients (2.7%). Although ISS (p=0.053), AIS head (p=0.469), on-scene GCS (p=0.151), on-scene time (p=0.530), GOS (p=0.748) and in-hospital mortality (p=0.431) were similar compared with correctly positioned ETI tubes, three esophageal intubation patients died due to hypoxemic complications.
In our study sample, out-of-hospital emergency ETI in severely injured patients was associated with a considerable tube misplacement rate. For safety, increased compliance to consequently use available technologies (eg, capnography, video laryngoscopy) for emergency ETI should be warranted.
Level of Evidence IIA.
气管插管（ETI）是严重受伤患者院外紧急气道管理的金标准。由于情况紧急、患者表现不佳以及环境恶劣，气管插管可能容易出现机械并发症和失败情况。
在一项回顾性研究（2011年1月至2013年12月）中，对所有在进入一级创伤中心之前接受院外ETI的患者进行了连续分析。排除了使用声门上气道的患者、正在进行心肺复苏的患者以及机构间转运的患者。主要研究终点是未识别的导管位置异常发生率；次要终点是格拉斯哥预后量表（GOS）以及根据现场格拉斯哥昏迷量表（GCS）、损伤严重程度评分（ISS）、简明损伤量表头部（AIS头部）和现场时间调整后的院内死亡率。
在1176例患者中，151例接受了院外ETI。入院时，9例患者（5.9%）被识别出导管位置异常。5例患者（3.3%）被检测到意外且未被识别的食管插管，4例患者（2.7%）被检测到支气管插管。尽管与导管位置正确的ETI相比，ISS（p = 0.053）、AIS头部（p = 0.469）、现场GCS（p = 0.151）、现场时间（p = 0.530）、GOS（p = 0.748）和院内死亡率（p = 0.431）相似，但3例食管插管患者因低氧血症并发症死亡。
在我们的研究样本中，严重受伤患者的院外紧急ETI与相当高的导管误置率相关。为确保安全，应提高对在紧急ETI中持续使用可用技术（如二氧化碳波形图、视频喉镜）的依从性。
证据级别IIA。
