Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON.
Department of Surgery, Saint Michael`s Hospital, University of Toronto, Toronto, ON.
CJEM. 2020 Sep;22(S2):S89-S103. doi: 10.1017/cem.2020.404.
Military Forward Aeromedical Evacuation and civilian Helicopter Emergency Medical Services are widely used to conduct Primary Aeromedical Retrieval. Crew composition in Primary Aeromedical Retrieval missions varies considerably. The ideal composition is unknown. Thus, we conducted a descriptive systematic review on mortality and other outcomes for different Primary Aeromedical Retrieval crew compositions.
Medline, Embase, and Cochrane Controlled Trials Register were searched up to January 2020. Results were reported per Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Studies of adult trauma air transported by different crews were included. Population, injury severity, crew composition, procedures, and outcomes, including mortality, were abstracted. Risk of bias was assessed using previously validated tools. A lack of reported effect measures precluded a quantitative analysis.
Sixteen studies met inclusion criteria (3 prospective studies, 1 case-control, and 12 retrospective). Overall, studies reported a mortality benefit associated with advanced health care providers. This was most apparent in patients with severe but survivable injuries. In this population, early rapid sequence induction, endotracheal intubation, mechanical ventilation, thoracostomies, blood products transfusion, and treatment of hemorrhagic shock are better performed by advanced providers and may improve outcomes. The quality of evidence reported a moderate risk of bias in the included studies.
Overall, findings were divergent but showed a trend to decreased mortality in patients treated by advanced providers with interventions beyond the basic paramedic level. This trend was most significant in patients with severe but survivable injuries. These results should be cautiously interpreted because most studies were observational, had small sample sizes, and had a high potential for confounding factors.
军事前方航空医疗后送和民用直升机紧急医疗服务广泛用于进行初步航空医疗救援。初步航空医疗救援任务的机组人员组成差异很大。理想的组成尚不清楚。因此，我们对不同初步航空医疗救援机组人员组成的死亡率和其他结果进行了描述性系统评价。
检索了 Medline、Embase 和 Cochrane 对照试验登记处，截至 2020 年 1 月。按照系统评价和荟萃分析的首选报告项目报告结果。纳入了不同机组人员运送的成年创伤性空中转运的研究。提取了人群、伤害严重程度、机组人员组成、程序和结果，包括死亡率。使用先前验证的工具评估偏倚风险。缺乏报告的效应测量值排除了定量分析。
16 项研究符合纳入标准（3 项前瞻性研究、1 项病例对照研究和 12 项回顾性研究）。总体而言，研究报告称，高级医疗保健提供者与死亡率降低相关。这在严重但可存活的伤害患者中最为明显。在这一人群中，早期快速序列诱导、气管插管、机械通气、胸腔穿刺、血液制品输注和出血性休克的治疗由高级提供者更好地进行，可能会改善结果。报告的证据质量在纳入的研究中存在中度偏倚风险。
总体而言，结果存在分歧，但表明接受高级提供者治疗的患者死亡率降低，其干预措施超出了基本护理人员的水平。在严重但可存活的伤害患者中，这种趋势最为明显。由于大多数研究为观察性研究，样本量较小，且存在较高的混杂因素，因此这些结果应谨慎解释。
