Research and Development Unit, FinnHEMS, Vantaa, Finland; University of Eastern Finland, Kuopio, Finland.
Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland.
Br J Anaesth. 2022 Feb;128(2):e135-e142. doi: 10.1016/j.bja.2021.08.029. Epub 2021 Oct 14.
Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management.
We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension.
In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups.
Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
院前麻醉是直升机紧急医疗服务（HEMS）的核心能力。在这种情况下，医生的院前麻醉病例量是否会影响结果尚不清楚。我们旨在调查医生的病例量是否与死亡率或医疗管理的差异有关。
我们对 2013 年 1 月 1 日至 2019 年 8 月 31 日期间由 HEMS 医生进行药物辅助插管的患者进行了基于登记的队列研究。主要结局是 30 天死亡率，通过多变量逻辑回归分析控制患者相关变量进行分析。每位患者的病例量由主治医生在过去 12 个月中管理的院前麻醉数量决定。解释变量为按低（0-12）、中（13-36）和高（≥37）病例量分组的医生病例量。次要结局是医疗管理的特征，包括低氧血症和低血压的发生率。
在 4818 名患者中，医生的病例量分别为低病例量组（511 名患者）、中病例量组（2033 名患者）和高病例量组（2274 名患者）。较高的医生病例量与较低的 30 天死亡率相关（每增加一个对数病例的比值比为 0.79 [95%置信区间：0.64-0.98]）。高病例量的医生提供者现场时间更短（中位数 28 [25 至 75 百分位数：22-38]，而中间病例量组为 32 [23-42]，最低病例量组为 32 [23-43]；P<0.001），并且气管插管的首次成功率更高（98%，而分别为 93%和 90%；P<0.001）。各组之间低氧血症和低血压的发生率相似。
由病例量较高的医生提供的院前麻醉后，死亡率似乎较低。
