Song So Ra, Kim Ki Hong, Park Jeong Ho, Song Kyoung Jun, Shin Sang Do
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, Seoul, Republic of Korea.
Am J Emerg Med. 2023 Mar;65:24-30. doi: 10.1016/j.ajem.2022.12.021. Epub 2022 Dec 22.
This study aimed to evaluate the association between prehospital airway type and oxygenation and ventilation in out-of-hospital cardiac arrest (OHCA).
This retrospective observational study included OHCA patients who visited the emergency departments (EDs) between October 2015 and June 2021. The study groups were categorized according to the prehospital airway type: endotracheal intubation (ETI), supraglottic airway (SGA), or bag-valve-mask ventilation (BVM). The primary outcome was good oxygenation: partial pressure of oxygen (PaO2) ≥ 60 mmHg on the first arterial blood gas (ABG) test. The secondary outcome was good ventilation: partial pressure of carbon dioxide (PaCO2) ≤ 45 mmHg. Multivariate logistic regression was conducted to calculate the adjusted odds ratio (AOR) and 95% confidence interval (CI).
A total of 7,372 patients were enrolled during the study period: 1,819 patients treated with BVM, 706 with ETI, and 4,847 who underwent SGA. In multivariable logistic regression analysis for good oxygenation outcomes, the ETI group showed a higher AOR than the BVM group (AOR [95% CIs]: 1.30 [1.06-1.59] in ETI and 1.05 [0.93-1.20] in SGA groups). Regarding good ventilation, the ETI group showed a higher AOR, and the SGA group showed a lower AOR compared to the BVM group (AOR [95% CIs] 1.33 [1.02-1.74] in the ETI and 0.83 (0.70-0.99) in the SGA groups). There was no significant difference in survival to discharge.
ETI was significantly associated with good oxygenation and good ventilation compared to BVM in patients with OHCA, particularly during longer transports. This should be taken into consideration when deciding the prehospital advanced airway management in patients with OHCA.
本研究旨在评估院外心脏骤停（OHCA）患者的院前气道类型与氧合及通气之间的关联。
这项回顾性观察研究纳入了2015年10月至2021年6月期间前往急诊科（ED）就诊的OHCA患者。研究组根据院前气道类型进行分类：气管插管（ETI）、声门上气道（SGA）或袋阀面罩通气（BVM）。主要结局为良好氧合：首次动脉血气（ABG）检查时氧分压（PaO2）≥60 mmHg。次要结局为良好通气：二氧化碳分压（PaCO2）≤45 mmHg。进行多因素逻辑回归分析以计算调整后的优势比（AOR）和95%置信区间（CI）。
研究期间共纳入7372例患者：1819例接受BVM治疗，706例接受ETI治疗，4847例接受SGA治疗。在关于良好氧合结局的多因素逻辑回归分析中，ETI组的AOR高于BVM组（AOR[95%CI]：ETI组为1.30[1.06 - 1.59]，SGA组为1.05[0.93 - 1.20]）。关于良好通气，与BVM组相比，ETI组的AOR较高，SGA组的AOR较低（AOR[95%CI]：ETI组为1.33[1.02 - 1.74]，SGA组为0.83[0.70 - 0.99]）。出院生存率无显著差异。
与BVM相比，ETI与OHCA患者的良好氧合和良好通气显著相关，尤其是在较长距离转运期间。在决定OHCA患者的院前高级气道管理时应考虑这一点。
