Huebinger Ryan M, Stilgenbauer Hutch, Jarvis Jeff L, Ostermayer Daniel G, Schulz Kevin, Wang Henry E
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, TX, United States.
McGovern Medical School at The University of Texas Health Science Center at Houston (UTHealth), Department of Emergency Medicine, Houston, TX, United States.
Resuscitation. 2021 May;162:143-148. doi: 10.1016/j.resuscitation.2021.02.031. Epub 2021 Feb 25.
Endotracheal intubation is an import component of out-of-hospital cardiac arrest (OHCA) resuscitation. In this analysis, we evaluate the association of video laryngoscopy (VL) with first pass success and return of spontaneous circulation (ROSC) using a national OHCA cohort.
We analyzed 2018 data from ESO Inc. (Austin, TX), a national prehospital electronic health record. We included all adult, non-traumatic cardiac arrests undergoing endotracheal intubation. We defined VL and direct laryngoscopy (DL) based on paramedic recorded intubation device. The primary outcomes were first pass success, ROSC, and sustained ROSC. Using multivariable, mixed models, we determined the association between VL and first pass success rate, ROSC, and sustained ROSC (survival to ED or ROSC in the field for greater than 20 min), fitting agency as a random intercept and adjusting for confounders.
We included 22,132 patients cared for by 914 EMS agencies, including 5702 (25.7%) VL and 16,430 (74.2%) DL. Compared to DL, VL had a lower rate of bystander CPR, but other characteristics were similar between the groups. VL exhibited higher first pass success than DL (75.1% v 69.5%, p < .001). On mixed model analysis, VL was associated with a higher first pass success (OR 1.5, CI 1.3-1.6) but not ROSC (OR 1.1, CI 0.97-1.2) or sustained ROSC (OR 1.1, CI 0.9-1.2).
While associated with higher FPS, VL was not associated with increased rate of ROSC. The role of VL in OHCA remains unclear.
气管插管是院外心脏骤停（OHCA）复苏的重要组成部分。在本分析中，我们使用全国OHCA队列评估视频喉镜（VL）与首次插管成功及自主循环恢复（ROSC）之间的关联。
我们分析了ESO公司（德克萨斯州奥斯汀）2018年的数据，这是一份全国院前电子健康记录。我们纳入了所有接受气管插管的成年非创伤性心脏骤停患者。我们根据护理人员记录的插管设备定义VL和直接喉镜检查（DL）。主要结局为首次插管成功、ROSC和持续性ROSC。使用多变量混合模型，我们确定了VL与首次插管成功率、ROSC和持续性ROSC（存活至急诊科或在现场ROSC超过20分钟）之间的关联，将急救机构作为随机截距进行拟合，并对混杂因素进行校正。
我们纳入了由914个急救机构护理的22132例患者，其中包括5702例（25.7%）VL和16430例（74.2%）DL。与DL相比，VL的旁观者心肺复苏率较低，但两组的其他特征相似。VL的首次插管成功率高于DL（75.1%对69.5%，p<0.001）。在混合模型分析中，VL与较高的首次插管成功率相关（OR 1.5，CI 1.3 - 1.6），但与ROSC（OR 1.1，CI 0.97 - 1.2）或持续性ROSC（OR 1.1，CI 0.9 - 1.2）无关。
虽然VL与较高的首次插管成功率相关，但与ROSC发生率增加无关。VL在OHCA中的作用仍不明确。
