Departement of Anaesthesiology and Intensive Care Medicine AUVA Trauma Centre Salzburg, Academic Teaching Hospital of the Paracelsus Medical University, Dr.-Franz-Rehrl-Platz 5, Salzburg, Austria.
Ludwig Boltzmann Institute for Experimental and Clinical Traumatology, AUVA Trauma Research Centre, Vienna, Austria.
Scand J Trauma Resusc Emerg Med. 2019 Aug 28;27(1):80. doi: 10.1186/s13049-019-0656-9.
Pre-hospital emergency anaesthesia and tracheal intubation are life-saving interventions in trauma patients. However, there is evidence suggesting that the risks associated with both procedures outweigh the benefits. Thus, we assessed whether induction of anaesthesia and tracheal intubation of trauma patients can be postponed in spontaneously breathing patients until emergency room (ER) admission without increasing mortality.
Retrospective analysis of major trauma patients either intubated on-scene by an emergency medical service (EMS) physician (pre-hospital intubation, PHI) or within the first 10 min after admission at a level 1 trauma centre (emergency room intubation, ERI). Data was extracted from the German Trauma Registry, hospital patient data management and electronic clinical information system.
From a total of 946 major trauma cases documented between 2010 and 2017, 294 patients matched the study inclusion criteria. Mortality rate of PHI (N = 258) vs. ERI (N = 36) patients was 26.4% vs. 16.7% (p = 0.3). After exclusion of patients with severe traumatic brain injury and/or pre-hospital cardiac arrest, mortality rate of PHI (N = 100) vs. ERI patients (N = 29) was 6% vs. 17.2%, (p = 0.07). Median on-scene time was significantly (p < 0.01) longer in PHI (30 min; IQR: 21-40) vs. ERI patients (20 min; IQR: 15-28).
There was no statistical difference in mortality rates of spontaneously breathing trauma patients intubated on-scene when compared with patients intubated immediately after hospital admission. Due to the retrospective study design and small case number, further studies evaluating the impact of airway management timing in sufficiently breathing trauma patients are warranted.
在创伤患者中，院前急救麻醉和气管插管是挽救生命的干预措施。然而，有证据表明，这两种操作的风险大于益处。因此，我们评估了在不增加死亡率的情况下，是否可以将创伤患者的麻醉诱导和气管插管推迟到急诊室（ER）入院时，对于自主呼吸的患者。
回顾性分析了由急救医疗服务（EMS）医生在现场插管的严重创伤患者（院前插管，PHI）或在一级创伤中心入院后 10 分钟内插管的患者（急诊室插管，ERI）。数据来自德国创伤登记处、医院患者数据管理和电子临床信息系统。
在 2010 年至 2017 年期间记录的总共 946 例严重创伤病例中，有 294 例符合研究纳入标准。PHI（N=258）与 ERI（N=36）患者的死亡率分别为 26.4%和 16.7%（p=0.3）。排除严重创伤性脑损伤和/或院前心脏骤停的患者后，PHI（N=100）与 ERI 患者（N=29）的死亡率分别为 6%和 17.2%（p=0.07）。PHI 患者的现场时间明显（p<0.01）长于 ERI 患者（30 分钟；IQR：21-40）（20 分钟；IQR：15-28）。
与立即入院插管的患者相比，自主呼吸的创伤患者现场插管的死亡率无统计学差异。由于研究设计为回顾性和病例数较少，因此需要进一步研究评估在有足够自主呼吸的创伤患者中气道管理时机的影响。
