气囊辅助气管插管在实用气道复苏试验中。
Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial.
机构信息
Department of Emergency Medicine, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, WI, United States.
出版信息
Resuscitation. 2021 Jan;158:215-219. doi: 10.1016/j.resuscitation.2020.11.003. Epub 2020 Nov 9.
OBJECTIVE
Paramedics may perform endotracheal intubation (ETI) while treating patients with out-of-hospital cardiac arrest (OHCA). The gum elastic Bougie (Bougie) is an intubation adjunct that may optimize intubation success. There are few reports of Bougie-assisted intubation in OHCA nor its association with outcomes. We compared intubation success rates and OHCA outcomes between Bougie-assisted and non-Bougie ETI in the out-of-hospital Pragmatic Airway Resuscitation Trial (PART).
METHODS
This was a secondary analysis of patients receiving ETI enrolled in the Pragmatic Airway Resuscitation Trial (PART), a multicenter clinical trial comparing intubation-first vs. laryngeal tube-first strategies of airway management in adult OHCA. The primary exposure was use of Bougie for ETI-assistance. The primary endpoint was first-pass ETI success. Secondary endpoints included overall ETI success, time to successful ETI, return of spontaneous circulation, 72-h survival, hospital survival and hospital survival with favorable neurologic status (Modified Rankin Score ≤3). We analyzed the data using Generalized Estimating Equations and Cox Regression, adjusting for known confounders.
RESULTS
Of the 3004 patients enrolled in PART, 1227 received ETI, including 440 (35.9%) Bougie-assisted and 787 (64.1%) non-Bougie ETIs. First-pass ETI success did not differ between Bougie-assisted and non-Bougie ETI (53.1% vs. 42.8%; adjusted OR 1.12, 95% CI: 0.97-1.39). ETI overall success was slightly higher in the Bougie-assisted group (56.2% vs. 49.1%; adjusted OR 1.19, 95% CI: 1.01-1.32). Time to endotracheal tube placement or abandonment was longer for Bougie-assisted than non-Bougie ETI (median 13 vs. 11 min; adjusted HR 0.63, 95% CI: 0.45-0.90). While survival to hospital discharge was lower for Bougie-assisted than non-Bougie ETI (3.6% vs. 7.5%; adjusted OR 0.94, 95% CI: 0.92-0.96), there were no differences in ROSC, 72-h survival or hospital survival or hospital survival with favorable neurologic status.
CONCLUSION
While exhibiting slightly higher ETI overall success rates, Bougie-assisted ETI entailed longer airway placement times and potentially lower survival. The role of the Bougie assistance in ETI of OHCA remains unclear.
目的
急救人员在治疗院外心脏骤停（OHCA）患者时可能会进行气管内插管（ETI）。弹性橡皮气管导管（Bougie）是一种可能优化插管成功率的插管辅助工具。关于 Bougie 辅助插管在 OHCA 中的应用及其与结果的关系，报道甚少。我们比较了在院外实用气道复苏试验（PART）中接受 ETI 的患者中，Bougie 辅助与非 Bougie ETI 之间的插管成功率和 OHCA 结局。
方法
这是对接受 ETI 的患者进行的二次分析，这些患者纳入了实用气道复苏试验（PART），这是一项多中心临床试验，比较了成人 OHCA 中插管优先与喉管优先的气道管理策略。主要暴露因素是使用 Bougie 辅助 ETI。主要终点是首次通过 ETI 成功率。次要终点包括整体 ETI 成功率、成功 ETI 的时间、自主循环恢复、72 小时生存率、住院生存率和具有良好神经功能状态的住院生存率（改良 Rankin 评分≤3）。我们使用广义估计方程和 Cox 回归分析了数据，调整了已知的混杂因素。
结果
PART 共纳入 3004 例患者，其中 1227 例接受 ETI，包括 440 例（35.9%）Bougie 辅助 ETI 和 787 例（64.1%）非 Bougie ETI。首次通过 ETI 成功率在 Bougie 辅助与非 Bougie ETI 之间无差异（53.1% vs. 42.8%；调整后的 OR 1.12，95%CI：0.97-1.39）。Bougie 辅助 ETI 的整体 ETI 成功率略高（56.2% vs. 49.1%；调整后的 OR 1.19，95%CI：1.01-1.32）。Bougie 辅助 ETI 放置或放弃气管内导管的时间比非 Bougie ETI 长（中位数 13 分钟 vs. 11 分钟；调整后的 HR 0.63，95%CI：0.45-0.90）。与非 Bougie ETI 相比，Bougie 辅助 ETI 患者的住院存活率较低（3.6% vs. 7.5%；调整后的 OR 0.94，95%CI：0.92-0.96），但 ROSC、72 小时生存率、住院生存率或具有良好神经功能状态的住院生存率无差异。
结论
尽管 Bougie 辅助 ETI 表现出略高的整体 ETI 成功率，但气管插管时间延长，且生存可能性降低。Bougie 辅助在 OHCA 中的 ETI 中的作用仍不清楚。
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