Emergency Department, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia.
Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia.
Emerg Med Australas. 2022 Jun;34(3):347-354. doi: 10.1111/1742-6723.13890. Epub 2021 Nov 8.
Intubation is an important competency for emergency doctors. Emergency patients are often unstable, with undifferentiated conditions. There is little time to prepare these patients prior to intubation and so ED intubation may differ from intubation in intensive care units and operating theatres. The present study aims to describe the characteristics of emergency intubation after an administrative policy change within a tertiary teaching hospital in Jakarta, allowing non-anaesthetists to perform intubation in the ED.
Prospective data were collected regarding patients of all age groups who were intubated at the ED of Cipto Mangunkusumo General Hospital, Jakarta, from February 2018 to January 2019. Patient characteristics, intubation attempts, medications used, complications, and disposition were recorded in a self-reported airway registry based on the Australian and New Zealand Emergency Department Airway Registry (ANZEDAR) form.
During the 12-month study period, 231 patients, or 41.5% of ED intubated patients were enrolled in the study, and there were 268 intubation attempts on these enrolled patients. The first-pass success rate was 207 out of 231 patients, or 89.6%, with anaesthetist (88.9%), better than emergency doctors (55.4%). Complications were reported in 51 patients, or 22.0%, with desaturation and hypotension being the most common. Thirty-three patients, or 14.3%, died in the ED before being transferred to another unit.
The first-pass success rate is comparable with international data. Non-anaesthetic physicians must improve their experience to achieve a favourable success rate. The data on complications highlight the need for improvement in Indonesian ED intubation practices.
插管是急诊医生的一项重要技能。急诊患者通常情况不稳定，病情尚未明确。在对这些患者进行插管之前，几乎没有时间做准备，因此急诊插管可能与重症监护病房和手术室的插管有所不同。本研究旨在描述雅加达一家三级教学医院在行政政策改变后，允许非麻醉医生在急诊科进行插管后，急诊插管的特点。
前瞻性收集 2018 年 2 月至 2019 年 1 月期间在雅加达 Cipto Mangunkusumo 综合医院急诊科插管的所有年龄段患者的数据。患者特征、插管尝试、使用的药物、并发症和处置情况均记录在根据澳大利亚和新西兰急诊科气道登记册（ANZEDAR）表格的自我报告气道登记册中。
在 12 个月的研究期间，231 名患者（占急诊科插管患者的 41.5%）入组研究，对这些入组患者进行了 268 次插管尝试。231 名患者中有 207 名（89.6%）首次尝试成功，其中麻醉师（88.9%）优于急诊医生（55.4%）。51 名患者（22.0%）报告出现并发症，最常见的是低氧血症和低血压。33 名患者（14.3%）在转往其他科室前在急诊科死亡。
首次尝试成功率与国际数据相当。非麻醉医生必须提高经验以实现有利的成功率。并发症数据突出表明需要改进印度尼西亚急诊科插管实践。
