CareFlight, Wentworthville, New South Wales, Australia.
School of Medicine, University of Sydney, Sydney, New South Wales, Australia.
Emerg Med J. 2019 Nov;36(11):678-683. doi: 10.1136/emermed-2019-208421. Epub 2019 Oct 3.
Paediatric intubation is a high-risk procedure for ground emergency medical services (GEMS). Physician-staffed helicopter EMS (PS-HEMS) may bring additional skills, drugs and equipment to the scene including advanced airway management beyond the scope of GEMS even in urban areas with short transport times. This study aimed to evaluate prehospital paediatric intubation performed by a PS-HEMS when dispatched to assist GEMS in a large urban area and examine how often PS-HEMS provided airway intervention that was not or could not be provided by GEMS.
We performed a retrospective observational study from July 2011 to December 2016 of a PS-HEMS in a large urban area (Sydney, Australia), which responds in parallel to GEMS. GEMS intubate without adjuvant neuromuscular blockade, whereas the PS-HEMS use neuromuscular blockade and anaesthetic agents. We examined endotracheal intubation success rate, first-look success rate and complications for the PS-HEMS and contrasted this with the advanced airway interventions provided by GEMS prior to PS-HEMS arrival.
Overall intubation success rate was 62/62 (100%) and first-look success was 59/62 (95%) in the PS-HEMS-treated group, whereas the overall success rate was 2/7 (29%) for the GEMS group. Peri-intubation hypoxia was documented in 5/65 (8%) of the PS-HEMS intubation attempts but no other complications were reported. However, 3/7 (43%) of the attempted intubations by GEMS were oesophageal intubations, two of which were unrecognised.
PS-HEMS have high success with low complication rates in paediatric prehospital intubation. Even in urban areas with rapid GEMS response, PS-HEMS activated in parallel can provide safe and timely advanced prehospital airway management for seriously ill and injured children beyond the scope of GEMS practice. Review of GEMS airway management protocols and the PS-HEMS case identification and dispatch system in Sydney is warranted.
儿科插管是地面紧急医疗服务（GEMS）的高风险操作。配备医师的直升机紧急医疗服务（PS-HEMS）可能会在现场提供额外的技能、药物和设备，包括高级气道管理，超出 GEMS 的范围，即使在城市地区，转运时间也很短。本研究旨在评估在大型城市地区派遣 PS-HEMS 协助 GEMS 时进行的院前儿科插管，并检查 PS-HEMS 提供的气道干预措施在何种情况下 GEMS 无法提供或不能提供。
我们对 2011 年 7 月至 2016 年 12 月期间在大型城市（澳大利亚悉尼）运作的 PS-HEMS 进行了回顾性观察研究，该服务与 GEMS 并行响应。GEMS 在进行插管时不使用辅助神经肌肉阻滞剂，而 PS-HEMS 使用神经肌肉阻滞剂和麻醉剂。我们检查了 PS-HEMS 的气管插管成功率、首次观察成功率和并发症，并将其与 PS-HEMS 到达前 GEMS 提供的高级气道干预措施进行了对比。
PS-HEMS 治疗组的总体插管成功率为 62/62（100%），首次观察成功率为 59/62（95%），而 GEMS 组的总体成功率为 2/7（29%）。在 PS-HEMS 插管尝试中，有 5/65（8%）记录到插管期间缺氧，但未报告其他并发症。然而，GEMS 进行的 3/7（43%）尝试性插管是食管插管，其中 2 例未被识别。
PS-HEMS 在儿科院前插管中成功率高，并发症发生率低。即使在 GEMS 反应迅速的城市地区，同时激活的 PS-HEMS 也可以为病情严重和受伤的儿童提供安全、及时的高级院前气道管理，超出 GEMS 实践的范围。有必要审查悉尼的 GEMS 气道管理方案和 PS-HEMS 病例识别和调度系统。
