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院前急诊医学中操作者医学专业对气管插管率的影响——一项回顾性队列研究

Impact of Operator Medical Specialty on Endotracheal Intubation Rates in Prehospital Emergency Medicine-A Retrospective Cohort Study.

作者信息

Fehlmann Christophe A, Chan Michèle, Betend Romain, Novotny-Court Fiona, Suppan Mélanie, Savoldelli Georges L, Suppan Laurent

机构信息

Division of Emergency, Department of Anaesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland.

School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON K1G 5Z3, Canada.

出版信息

J Clin Med. 2022 Apr 2;11(7):1992. doi: 10.3390/jcm11071992.

Abstract

Prehospital endotracheal intubation (ETI) can be challenging, and the risk of complications is higher than in the operating room. The goal of this study was to compare prehospital ETI rates between anaesthesiologists and non-anaesthesiologists. This retrospective cohort study compared prehospital interventions performed by either physicians from the anaesthesiology department (ADP) or physicians from another department (NADP, for non-anaesthesiology department physicians). The primary outcome was the prehospital ETI rate. Overall, 42,190 interventions were included in the analysis, of whom 68.5% were performed by NADP. Intubation was attempted on 2797 (6.6%) patients, without any difference between NADPs and ADPs (6.5 versus 6.7%, = 0.555). However, ADPs were more likely to proceed to an intubation when patients were not in cardiac arrest (3.4 versus 3.0%, = 0.026), whereas no difference was found regarding cardiac arrest patients (65.2 versus 67.7%, = 0.243) ( for homogeneity = 0.005). In a prehospital physician-staffed emergency medical service, overall ETI rates did not depend on the frontline operator's medical specialty background. ADPs were, however, more likely to proceed with ETI than NADPs when patients were not in cardiac arrest. Further studies should help to understand the reasons for this difference.

摘要

院前气管插管(ETI)具有挑战性,且并发症风险高于手术室。本研究的目的是比较麻醉医生和非麻醉医生的院前ETI率。这项回顾性队列研究比较了麻醉科医生(ADP)或其他科室医生(NADP,即非麻醉科医生)进行的院前干预措施。主要结局是院前ETI率。总体而言,42190项干预措施纳入分析,其中68.5%由NADP实施。对2797例(6.6%)患者尝试进行插管,NADP和ADP之间无差异(6.5%对6.7%,P = 0.555)。然而,当患者未发生心脏骤停时,ADP更有可能进行插管(3.4%对3.0%,P = 0.026),而对于心脏骤停患者未发现差异(65.2%对67.7%,P = 0.243)(同质性检验P = 0.005)。在由医生配备人员的院前急救医疗服务中,总体ETI率并不取决于一线操作人员的医学专业背景。然而,当患者未发生心脏骤停时,ADP比NADP更有可能进行ETI。进一步的研究应有助于理解这种差异的原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/610f/8999662/16cf833ec978/jcm-11-01992-g001.jpg

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