Emergency medicine, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
Emergency medicine, Brown University Alpert Medical School, Providence, Rhode Island, USA.
Emerg Med J. 2021 Mar;38(3):178-183. doi: 10.1136/emermed-2019-208521. Epub 2021 Jan 12.
Formalised emergency departments (ED) are in early development in sub-Saharan Africa and there are limited data on emergency airway management in those settings. This study evaluates characteristics and outcomes of ED endotracheal intubation, as well as risk factors for mortality, at a teaching hospital in Rwanda.
This was a prospective observational study of consecutive patients requiring endotracheal intubation at the University Teaching Hospital of Kigali ED conducted between 1 January and 31 December 2017. A standardised data collection tool was used to record patient demographics, preintubation clinical presentation, indication for intubation, vital signs. medications and equipment used, and periintubation complications. The primary outcome was in-hospital mortality. Univariate associations were determined for risks of mortality.
Of 198 intubations were analysed, 72.7% were male and the median age was 35 years (IQR 23-51). Airway protection was the most common indication for intubation (73.7%). Rapid sequence intubation was performed in 74.2% of cases; sedative-only facilitated intubation in 20.6% and non-drug assisted in 5.2%. The most common agents used were Ketamine for sedation (85.4%) and vecuronium for paralysis (65.7%). All patients were successfully intubated within three attempts, 85.4% on the first attempt. During intubation, 23.1% of patients experienced hypoxia, 6.7% aspiration and 3.6% cardiac arrest. Median ED length of stay was 2 days. Outcome data were available for 164 patients of whom 67.7% died. Bonferroni-corrected univariate analysis demonstrated that mortality was associated with higher postintubation shock index (p=0.0007) and lower postintubation systolic blood pressure (SBP) (p=0.0006).
The first-attempt and overall success rates for intubation in this ED in Rwanda were comparable to those in high-income countries (HIC). Mortality postintubation is associated with lower postintubation SBP and higher postintubation shock index. The high complication and mortality rates suggest the need for better resources and training to address differences in compared with HIC.
在撒哈拉以南非洲，规范化的急诊部（ED）仍处于早期发展阶段，关于这些环境下的紧急气道管理的数据有限。本研究评估了卢旺达一所教学医院 ED 中进行的气管插管的特征和结局，以及死亡率的危险因素。
这是一项在 2017 年 1 月 1 日至 12 月 31 日期间在基加利大学教学医院 ED 进行的连续需要气管插管的患者的前瞻性观察研究。使用标准化的数据收集工具记录患者的人口统计学、插管前的临床表现、插管指征、生命体征、用药和使用的设备以及围插管期并发症。主要结局是院内死亡率。确定了死亡率风险的单变量关联。
在分析的 198 例插管中，72.7%为男性，中位年龄为 35 岁（IQR 23-51）。气道保护是最常见的插管指征（73.7%）。在 74.2%的病例中进行了快速序贯插管；20.6%的病例使用镇静剂辅助插管，5.2%的病例未使用药物辅助插管。最常用的药物为氯胺酮镇静（85.4%）和维库溴铵麻痹（65.7%）。所有患者均在三次尝试内成功插管，第一次尝试的成功率为 85.4%。在插管过程中，23.1%的患者出现缺氧，6.7%的患者出现误吸，3.6%的患者出现心脏骤停。ED 中位住院时间为 2 天。164 例患者的结局数据可用，其中 67.7%死亡。经 Bonferroni 校正的单变量分析表明，死亡率与较高的插管后休克指数（p=0.0007）和较低的插管后收缩压（SBP）（p=0.0006）相关。
卢旺达该 ED 中的首次尝试和整体插管成功率与高收入国家（HIC）相当。插管后的死亡率与较低的插管后 SBP 和较高的插管后休克指数相关。高并发症和死亡率表明需要更好的资源和培训来解决与 HIC 相比的差异。
