Nottingham University Hospitals NHS Trust, Nottingham, UK; The Air Ambulance Service, Rugby, UK.
Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh, UK; Great North Air Ambulance Service, Eaglescliffe, UK.
Br J Anaesth. 2020 May;124(5):579-584. doi: 10.1016/j.bja.2020.01.023. Epub 2020 Mar 20.
Up to one in eight trauma patients arrive at a hospital with a partially or completely obstructed airway. The UK National Institute for health and Care Excellence (NICE) practice guidelines recommend that trauma patients requiring anaesthesia for definitive airway management receive this care within 45 min of an emergency call, preferably at the incident scene. How frequently this target is achieved remains unclear. We assessed the recorded time to pre-hospital emergency anaesthesia after trauma across UK helicopter emergency medical service (HEMS) units.
We retrospectively recorded time to pre-hospital emergency anaesthesia across all 20 eligible UK HEMS units (comprising 52 enhanced care teams) from April 1, 2017 to March 31, 2018. Times recorded for emergency notification, dispatch, arrival, and neuromuscular blocking agent administration were analysed.
HEMS undertook 1755 pre-hospital emergency anaesthetics for trauma across the UK during the study period. There were 1176/1755 (67%) episodes undertaken by helicopter response teams during daylight hours. The median time to pre-hospital emergency anaesthesia was 55 min (inter-quartile range: 45-70); anaesthesia within 45 min of the initial emergency call was achieved in 25% cases. Delayed dispatch time (>9 min) was associated with fewer patients receiving pre-hospital anaesthesia within 45 min (odds ratio: 7.7 [95% confidence intervals: 5.8-10.1]; P<0.0001).
The time to achieve pre-hospital emergency anaesthesia by UK HEMS frequently exceeds the recommended 45 min target. Reducing the time to dispatch of emergency medical teams may impact on the delivery of pre-hospital emergency anaesthesia.
多达八分之一的创伤患者在到达医院时存在部分或完全气道阻塞。英国国家卫生与保健卓越研究所（NICE）的实践指南建议，需要麻醉来进行确定性气道管理的创伤患者，应在紧急呼叫后 45 分钟内接受治疗，最好在事故现场进行。目前尚不清楚这一目标的实现频率。我们评估了英国直升机紧急医疗服务（HEMS）各单位创伤后接受院前紧急麻醉的记录时间。
我们回顾性地记录了 2017 年 4 月 1 日至 2018 年 3 月 31 日期间所有 20 个符合条件的英国 HEMS 单位（包括 52 个强化护理团队）的院前紧急麻醉时间。分析了紧急通知、派遣、到达和神经肌肉阻滞剂给药的时间。
在研究期间，HEMS 在英国共进行了 1755 例创伤院前紧急麻醉。有 1176/1755（67%）例是由直升机反应小组在白天进行的。院前紧急麻醉的中位时间为 55 分钟（四分位距：45-70）；在初始紧急呼叫后 45 分钟内完成麻醉的比例为 25%。延迟派遣时间（>9 分钟）与较少的患者在 45 分钟内接受院前麻醉相关（比值比：7.7 [95%置信区间：5.8-10.1]；P<0.0001）。
英国 HEMS 实现院前紧急麻醉的时间经常超过建议的 45 分钟目标。减少紧急医疗团队派遣时间可能会影响院前紧急麻醉的实施。
