Behrens Niels-Henning, Fischer Matthias, Krieger Tobias, Monaco Kathleen, Wnent Jan, Seewald Stephan, Gräsner Jan-Thorsten, Bernhard Michael
Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, Eichertstraße 3, 73035 Göppingen, Germany.
Department of Anaesthesiology and Intensive Care, ALB FILS Kliniken, Eichertstraße 3, 73035 Göppingen, Germany.
Resuscitation. 2020 Jul;152:157-164. doi: 10.1016/j.resuscitation.2020.04.015. Epub 2020 May 5.
An effective airway management is pivotal for treating hypoxia and to ensure reoxygenation during cardiopulmonary resuscitation (CPR). This matched-pair analysis from the German Resuscitation Registry (GRR) investigates the outcomes of various methods of airway management used on out-of-hospital cardiac arrest (OHCA) patients.
89,220 OHCA patients were reported between 01/01/2007 and 12/31/2017. After applying exclusion and inclusion criteria, the resulting 19,196 patient's data were analyzed. Endpoints were return of spontaneous circulation (ROSC), hospital admission, 24-h survival, hospital discharge, and discharge with cerebral performance categories 1,2 (CPC1,2). Three categories of airway management were defined: endotracheal tube ("ETT"), laryngeal tube ("LT_only"), and laryngeal to endotracheal tube exchange ("LTEX"). The groups were matched with respect to age, gender, aetiology or location of OHCA, witnessing or CPR by lay people, initial rhythm, and use of epinephrine and amiodarone.
"ETT" versus "LT_only" was associated with higher short- and long-term outcome rates and better neurological recovery (CPC_1.2: 7.7 vs. 5.8%, OR = 1.35, 95%-CI = 1.09-1.67, n = 5552). "LTEX" versus "LT_only" showed significantly higher ROSC- and 24-h survival rate (33.7 vs. 21.8%, OR = 1.82, 95%-CI = 1.51-2.2, n = 2302). "LTEX" versus "ETT" revealed significantly higher ROSC- and 24-h survival rate (34.6 vs. 30.4%, OR = 1.21, 95%-CI = 1.03-1.42, n = 2608).
"ETT" was associated with higher survival rates and better neurological outcomes in comparison to "LT_only". The strategy of "LTEX" versus "LT_only" or "ETT" was only associated with better short-term outcomes. Our observational registry data suggests that endotracheal intubation by physician staffed EMS is the optimal airway strategy for OHCA in our system.
有效的气道管理对于治疗缺氧以及确保心肺复苏（CPR）期间的再氧合至关重要。这项来自德国复苏登记处（GRR）的配对分析研究了院外心脏骤停（OHCA）患者使用的各种气道管理方法的结果。
2007年1月1日至2017年12月31日期间报告了89220例OHCA患者。应用排除和纳入标准后，对最终得到的19196例患者的数据进行了分析。观察终点为自主循环恢复（ROSC）、入院、24小时存活、出院以及脑功能分类1、2（CPC1、2）出院。定义了三类气道管理：气管插管（“ETT”）、喉管（“仅LT”）以及喉管至气管插管交换（“LTEX”）。各小组在年龄、性别、OHCA的病因或位置、是否有旁观者目击或进行CPR、初始心律以及肾上腺素和胺碘酮的使用方面进行了匹配。
“ETT”与“仅LT”相比，短期和长期结果率更高，神经功能恢复更好（CPC_1.2：7.7%对5.8%，OR = 1.35，95%置信区间 = 1.09 - 1.67，n = 5552）。“LTEX”与“仅LT”相比，ROSC和24小时存活率显著更高（33.7%对21.8%，OR = 1.82，95%置信区间 = 1.51 - 2.2，n = 2302）。“LTEX”与“ETT”相比，ROSC和24小时存活率显著更高（34.6%对30.4%，OR = 1.21，95%置信区间 = 1.03 - 1.42，n = 2608）。
与“仅LT”相比，“ETT”与更高的存活率和更好的神经功能结果相关。“LTEX”与“仅LT”或“ETT”相比的策略仅与更好的短期结果相关。我们的观察性登记数据表明，由医护人员进行气管插管是我们系统中OHCA的最佳气道策略。
