Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, Minnesota.
J Emerg Med. 2021 Nov;61(5):550-557. doi: 10.1016/j.jemermed.2021.09.016. Epub 2021 Nov 1.
The administration of sedation and neuromuscular blockade to facilitate extraglottic device (EGD) placement is known as rapid sequence airway (RSA). In the emergency department (ED), EGDs are used largely as rescue devices. In select patients, there may be significant advantages to using EGDs over laryngoscopy as the primary airway device in the ED.
Our study sought to describe the practice of RSA in the ED, including rates of successful oxygenation, ventilation, and complications from EGD use.
We identified patients in the ED between 2007 and 2017 who underwent RSA with the LMA® Fastrach™ (hereafter termed ILMA; Teleflex Medical Europe Ltd., Athlone, Ireland) placed as the first definitive airway management device. A trained abstractor performed chart and video review of the cases to determine patient characteristics, physician use of the ILMA, indication for ILMA placement, success of oxygenation and ventilation, success of intubation, and complications related to the device.
During the study period, 94 patients underwent RSA with the ILMA. Of those, 93 (99%) were successfully oxygenated and ventilated, and when intubation was attempted, 89% were able to be intubated through the ILMA. The incidence of vomiting and aspiration was 1% and 3%, respectively. There were 30 different attending physicians who supervised RSA and the median number was 2 per physician in the 10-year study period.
The practice of RSA with the ILMA in the ED is associated with a high rate of successful oxygenation, ventilation, and intubation with infrequent complications, even when performed by physicians with few experiences in the approach.
为了方便使用声门外设备（EGD）而给予镇静和神经肌肉阻滞的操作称为快速序贯气道（RSA）。在急诊科（ED），EGD 主要用作抢救设备。在某些患者中，在 ED 使用 EGD 作为主要气道设备可能具有明显的优势。
我们的研究旨在描述 ED 中 RSA 的实施情况，包括 EGD 使用的氧合、通气成功率和并发症。
我们确定了 2007 年至 2017 年期间在 ED 接受 RSA 并使用 LMA®Fastrach™（此后称为 ILMA；Teleflex Medical Europe Ltd.，爱尔兰奥唐奈）作为第一套明确的气道管理设备的患者。一名经过培训的记录员对病历和视频进行了回顾，以确定患者特征、医生使用 ILMA、ILMA 放置的适应证、氧合和通气成功率、插管成功率以及与设备相关的并发症。
在研究期间，94 例患者接受了 RSA 和 ILMA。其中，93 例（99%）成功氧合和通气，当尝试插管时，89%的患者能够通过 ILMA 进行插管。呕吐和误吸的发生率分别为 1%和 3%。有 30 名不同的主治医生监督 RSA，中位数为 2 名医生/10 年研究期。
ED 中使用 ILMA 进行 RSA 的实践与高成功率相关，氧合、通气和插管，并发症发生频率较低，即使是在经验较少的医生进行该操作时也是如此。
