Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig, Leipzig, Germany.
Institute of Legal Medicine, University Medical-Center Hamburg-Eppendorf, Hamburg, Germany.
Prehosp Disaster Med. 2022 Feb;37(1):57-64. doi: 10.1017/S1049023X21001382. Epub 2022 Jan 11.
Iatrogenic tracheal rupture is an unusual and severe complication that can be caused by tracheal intubation. The frequency, management, and outcome of iatrogenic tracheal rupture due to prehospital emergency intubation in adults by emergency response physicians has not yet been sufficiently explored.
Adult patients with iatrogenic tracheal ruptures due to prehospital emergency intubation admitted to an academic referral center over a 15-year period (2004-2018) with consideration of individual risk factors were analyzed.
Thirteen patients (eight female) with a mean age of 67 years met the inclusion criteria and were analyzed. Of these, eight tracheal ruptures (62%) were caused during the airway management of cardiopulmonary resuscitation (CPR). Stylet use and difficult laryngoscopy requiring multiple attempts were documented in eight cases (62%) and four cases (30%), respectively. Seven patients (54%) underwent surgery, while six patients (46%) were treated conservatively. The overall 30-day mortality was 46%; five patients died due to their underlying emergencies and one patient died of tracheal rupture. Three survivors (23%) recovered with severe neurological sequelae and four (30%) were discharged in good neurological condition. Survivors had significantly smaller mean rupture sizes (2.7cm versus 6.3cm; P <.001) and less cutaneous emphysema (n = 2 versus n = 6; P = .021) than nonsurvivors.
Iatrogenic tracheal rupture due to prehospital emergency intubation is a rare complication. Published risk factors are not consistently present and may not be applicable to identify patients at high risk, especially not in rescue situations. Treatment options depend on individual patient condition, whereas outcome largely depends on the underlying disease and rupture extension.
医源性气管破裂是一种罕见且严重的并发症，可由气管插管引起。急救医生在院前急救插管中导致成人医源性气管破裂的频率、处理方法和结果尚未得到充分探讨。
对 15 年来（2004 年至 2018 年）因院前急救插管导致医源性气管破裂并入住一家学术转诊中心的成年患者进行了分析，考虑了个体危险因素。
13 名（8 名女性）平均年龄为 67 岁的患者符合纳入标准并进行了分析。其中，8 例（62%）气管破裂是心肺复苏（CPR）期间气道管理引起的。8 例（62%）有使用管芯的记录，4 例（30%）有喉镜检查困难并需要多次尝试。7 例（54%）患者接受了手术治疗，6 例（46%）患者接受了保守治疗。总的 30 天死亡率为 46%；5 例患者因基础急症死亡，1 例患者死于气管破裂。3 名幸存者（23%）有严重的神经后遗症恢复，4 名（30%）出院时神经状况良好。幸存者的气管破裂平均尺寸明显较小（2.7cm 对 6.3cm；P <.001），皮肤气肿较少（n = 2 对 n = 6；P =.021）。
院前急救插管导致的医源性气管破裂是一种罕见的并发症。已发表的危险因素并不总是存在，并且可能无法识别高风险患者，尤其是在救援情况下。治疗选择取决于患者的个体情况，而结果在很大程度上取决于基础疾病和破裂范围。
