Department of Emergency Medicine, University of Florida College of Medicine, Gainesville, FloridaUSA.
Prehosp Disaster Med. 2022 Aug;37(4):561-565. doi: 10.1017/S1049023X22000802. Epub 2022 May 19.
Airway management is a controversial topic in modern Emergency Medical Services (EMS) systems. Among many concerns regarding endotracheal intubation (ETI), unrecognized esophageal intubation and observations of unfavorable neurologic outcomes in some studies raise the question of whether alternative airway techniques should be first-line in EMS airway management protocols. Supraglottic airway devices (SADs) are simpler to use, provide reliable oxygenation and ventilation, and may thus be an alternative first-line airway device for paramedics. In 2019, Alachua County Fire Rescue (ACFR; Alachua, Florida USA) introduced a novel protocol for advanced airway management emphasizing first-line use of a second-generation SAD (i-gel) for patients requiring medication-facilitated airway management (referred to as "rapid sequence airway" [RSA] protocol).
This was a one-year quality assurance review of care provided under the RSA protocol looking at compliance and first-pass success rate of first-line SAD use.
Records were obtained from the agency's electronic medical record (EMR), searching for the use of the RSA protocol, advanced airway devices, or either ketamine or rocuronium. If available, hospital follow-up data regarding patient condition and emergency department (ED) airway exchange were obtained.
During the first year, 33 advanced airway attempts were made under the protocol by 23 paramedics. Overall, compliance with the airway device sequence as specified in the protocol was 72.7%. When ETI was non-compliantly used as first-line airway device, the first-pass success rate was 44.4% compared to 87.5% with adherence to first-line SAD use. All prehospital SADs were exchanged in the ED in a delayed fashion and almost exclusively per physician preference alone. In no case was the SAD exchanged for suspected dislodgement evidenced by lack of capnography.
First-line use of a SAD was associated with a high first-pass attempt success rate in a real-life cohort of prehospital advanced airway encounters. No SAD required emergent exchange upon hospital arrival.
气道管理是现代急救医疗服务（EMS）系统中的一个有争议的话题。在许多关于气管插管（ETI）的问题中，一些研究中未被识别的食管插管和不良神经结局的观察结果提出了这样一个问题，即替代气道技术是否应该成为 EMS 气道管理协议中的一线治疗方法。声门上气道装置（SAD）使用起来更简单，能提供可靠的氧合和通气，因此可能是急救人员的一种替代一线气道装置。2019 年，美国佛罗里达州阿拉楚阿县消防救援局（ACFR）推出了一项新的高级气道管理协议，强调一线使用第二代 SAD（i-gel）治疗需要药物辅助气道管理的患者（称为“快速序贯气道”[RSA]协议）。
这是对根据 RSA 协议提供的护理进行的为期一年的质量保证审查，旨在观察一线 SAD 使用的依从性和首次通过成功率。
从机构的电子病历（EMR）中获取记录，搜索 RSA 协议、高级气道装置或氯胺酮或罗库溴铵的使用情况。如果有可用的患者情况和急诊部（ED）气道交换的医院随访数据，则获取相关数据。
在第一年，23 名急救人员根据协议进行了 33 次高级气道尝试。总体而言，根据协议规定的气道装置顺序的依从率为 72.7%。当 ETI 被不恰当地用作一线气道装置时，首次通过成功率为 44.4%，而遵守一线 SAD 使用的首次通过成功率为 87.5%。所有院前 SAD 都在 ED 中以延迟方式进行交换，几乎完全是根据医生的偏好单独进行的。在任何情况下，SAD 都没有因缺乏二氧化碳描记术而被怀疑移位而紧急更换。
在现实生活中的院前高级气道遇到的情况下，一线使用 SAD 与高首次通过尝试成功率相关。没有 SAD 需要在到达医院时紧急更换。
