院前确定性气道建立与创伤患者生存率的提高无关。
Prehospital definitive airway is not associated with improved survival in trauma patients.
机构信息
From the Israel Defense Forces, Medical Corps (A.M.T., R.N., N.T., A.S., T.B., A.B., E.G., J.C.), Tel Hashomer, Ramat Gan, Israel; Department of General Surgery and Transplantation-Surgery B (R.N.), Chaim Sheba Medical Center, Tel Hashomer, Affiliated to Sackler School of Medicine, Tel Aviv, Israel; The Azrieli Faculty of Medicine (A.B., E.G.), Bar-Ilan University, Safed, Israel; The Uniformed Services University of the Health Sciences (E.G.), Bethesda, Maryland.
出版信息
J Trauma Acute Care Surg. 2020 Aug;89(2S Suppl 2):S237-S241. doi: 10.1097/TA.0000000000002722.
BACKGROUND
The American College of Surgeons and the National Association of Emergency Medical Technicians advise securing a definitive airway if there is any doubt about the trauma patient's ability to maintain airway integrity. The objective of this study was to investigate the association between a success in securing a definitive airway in the prehospital setting and survival among trauma patients, in which the provider deemed a definitive airway was necessary.
METHODS
The study included all trauma patients recorded in the Israel Defense Forces Trauma Registry between the years 2006 and 2018 for whom a prehospital attempt of securing a definitive airway was documented. The successful definitive airway group was defined by explicit documentation of success in either endotracheal intubation or cricothyrotomy. Logistic regression was performed to determine the association between success in securing a definitive airway and survival.
RESULTS
A total of 566 (3.6%) trauma patients underwent attempts to secure a definitive airway (successful in 425 patients and unsuccessful in 141). Prehospital survival rates were similar (77.6% vs. 78.0%, p = 0.928) between the groups. Whether the definitive airway was successful did not affect the rates of prehospital survival, neither before (odds ratio, 0.98; 95% confidence interval, 0.61-1.54) nor after adjustment for the other factors (odds ratio, 0.91; 95% confidence interval, 0.55-1.46).
CONCLUSION
This study was unable to find an association between a successful definitive airway in the prehospital setting and survival, even after adjustment for injury characteristics and in multiple models. Furthermore, survival rates were high among trauma patients in which the provider deemed a definitive airway as necessary yet failed in securing one. These results suggest that the liberal use of these invasive airway procedures in the prehospital setting should be reconsidered.
LEVEL OF EVIDENCE
Retrospective study, lebel III.
背景
美国外科医师学会和美国国家紧急医疗技术员协会建议，如果创伤患者维持气道完整性的能力存在任何疑问，应确保建立明确的气道。本研究的目的是调查在创伤患者中，提供者认为需要建立明确的气道但未能成功的情况下，在院前环境中成功建立明确气道与生存之间的关联。
方法
本研究纳入了 2006 年至 2018 年期间记录在以色列国防军创伤登记处的所有创伤患者，这些患者的院前尝试建立明确气道均有记录。成功建立明确气道的定义是明确记录到气管插管或环甲膜切开术成功。使用逻辑回归来确定建立明确气道的成功率与生存之间的关联。
结果
共有 566 名（3.6%）创伤患者尝试建立明确气道（425 例成功，141 例失败）。两组患者的院前生存率相似（77.6%比 78.0%，p=0.928）。在未调整其他因素之前（比值比，0.98；95%置信区间，0.61-1.54）和调整其他因素之后（比值比，0.91；95%置信区间，0.55-1.46），建立明确气道的成功率均不影响院前生存率。
结论
本研究未能发现院前环境中成功建立明确气道与生存之间的关联，即使在调整损伤特征和多个模型后也是如此。此外，在提供者认为需要建立明确气道但未能成功的创伤患者中，生存率仍然很高。这些结果表明，应重新考虑在院前环境中自由使用这些有创气道程序。
证据水平
回顾性研究，等级 III。
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