Emergency Medical Service, Department of Emergency Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Department of Anaesthesiology, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland.
Air Med J. 2021 Nov-Dec;40(6):385-389. doi: 10.1016/j.amj.2021.08.012. Epub 2021 Sep 20.
Airway management to ensure sufficient gas exchange is of major importance in emergency care. Prehospital endotracheal intubation (ETI) by paramedics is a widely debated method to ensure a patent airway. ETI is performed with procedural sedation in comatose patients because of the regulation. The use of medications increases the rate of successful airway management compared with nonmedication ETI and may also improve outcomes in patients with traumatic brain injury. In the absence of an operative emergency physician and with long distances, paramedic-induced airway management may increase the survival of patients in selected scenarios. A paramedic-staffed helicopter emergency medical system in Northern Finland operates in a rural area without an emergency physician and paralytic medications and treats critically ill patients using basic or advanced life support ground units. The aim of this study was to evaluate the success rates of ETI performed by a small, appropriately trained, and experienced group of 8 nurse paramedics in an out-of-hospital setting.
The inclusion criterion for the study was an attempted intubation in patients with medical or traumatic indication for airway management by nurse paramedic.
Fifty-one patients were treated with ETI. The first-pass success rate was 72.5%, the second-pass success rate was 94.1%, and the overall success rate was 100% within 4 attempts. The median on-scene time was 54 minutes, and there were no signs of aspiration during laryngoscopy or after successful ETI. The primary mortality rate was 11.7%.
The use of a rigid standard operating procedure for paramedic rapid sequence induction, paralytics, a video laryngoscope, and a gum elastic bougie might positively affect the ETI first-pass success rate. A follow-up study after these future modifications is needed. This small study suggests that intubation might be 1 option for airway management by an experienced nonanesthesiologist in Lapland.
确保充分气体交换的气道管理在急救护理中至关重要。院前急救员行气管插管（ETI）是确保气道通畅的一种广泛争议的方法。由于法规规定，昏迷患者需要进行有程序性镇静的 ETI。与非药物 ETI 相比，药物的使用可提高气道管理的成功率，并且还可能改善创伤性脑损伤患者的结局。在没有手术急救医师且路途遥远的情况下，急救员诱导的气道管理可能会增加某些情况下患者的存活率。在芬兰北部，一个配备有急救员的直升机紧急医疗服务系统在没有急救医师和麻痹药物的农村地区运作，并使用基本或高级生命支持地面单位来治疗危重症患者。本研究的目的是评估由一小群经过适当培训和经验丰富的 8 名护士急救员在院外环境中进行 ETI 的成功率。
本研究的纳入标准为护士急救员对有医疗或创伤性气道管理指征的患者进行尝试性插管。
51 例患者接受了 ETI 治疗。首次尝试成功率为 72.5%，第二次尝试成功率为 94.1%，4 次尝试内总成功率为 100%。现场中位数时间为 54 分钟，在喉镜检查或成功 ETI 后均未出现吸入迹象。主要死亡率为 11.7%。
使用严格的急救员快速序贯诱导标准操作程序、肌松剂、视频喉镜和弹性牙胶棒可能会对 ETI 的首次尝试成功率产生积极影响。需要在进行这些未来修改后进行后续研究。这项小型研究表明，在拉普兰，经验丰富的非麻醉医师进行插管可能是一种气道管理的选择。
