14th Field Hospital, Fort Stewart, GA, United States of America; Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, United States of America.
Hennepin County Medical Center, Department of Emergency Medicine, Minneapolis, MN, United States of America.
Am J Emerg Med. 2023 Oct;72:95-100. doi: 10.1016/j.ajem.2023.07.024. Epub 2023 Jul 18.
Airway management is a critical component of the management of emergency department (ED) patients. The ED airway literature primarily focuses upon endotracheal intubation; relatively less is known about the ED use of extraglottic devices (EGDs). The goal of this study was to describe the frequency of use, success, and complications for EGDs among ED patients.
The National Emergency Airway Registry (NEAR) is a prospective, multi-center, observational registry. It captures data on all ED patients at participating sites requiring airway management. Intubating clinicians entered all data into an online system as soon as practical after each encounter. We conducted a secondary analysis of these data for all ED encounters in which EGD placement occurred. We used descriptive statistics to characterize these encounters.
Of 19,071 patients undergoing intubation attempts, 56 (0.3%) underwent EGD placement. Of 25 participating sites, 13 reported no cases undergoing EGD placement; the median number of EGDs placed per site was 2 (interquartile range 1-2.5, range 1-31). Twenty-nine (54%) patients had either hypotension or hypoxia prior to the start of airway management. Clinicians reported anticipation of a difficult airway in 55% and at least one difficult airway characteristic in 93% of these patients. Forty-one encounters entailed placement of a laryngeal mask airway (LMA®) Fastrach™, 33 of whom underwent subsequent successful intubation through the EGD and 7 of whom underwent intubation by alternative methods. An additional 10 encounters utilized a standard LMA® device. Providers placed 34 (61%) EGDs during the first intubation attempt. Seventeen EGD patients (30%) experienced peri-procedure adverse events, including 14 (25%) experiencing hypoxemia. None of these patients expired due to failed airways.
EGD use was rare in this multi-center ED registry. EGD occurred predominantly in patients with difficult airway characteristics with favorable airway management outcomes. Clinicians should consider this emergency airway device for patients with a suspected difficult airway.
气道管理是急诊科（ED）患者管理的重要组成部分。ED 气道文献主要侧重于气管内插管; 相对较少的是关于 ED 使用声门外设备（EGD）的知识。本研究的目的是描述 ED 患者使用 EGD 的频率、成功率和并发症。
国家紧急气道登记处（NEAR）是一项前瞻性、多中心、观察性登记处。它收集了参与站点中所有需要气道管理的 ED 患者的数据。插管临床医生在每次就诊后尽快将所有数据输入在线系统。我们对这些数据进行了二次分析，以了解所有进行 EGD 放置的 ED 遭遇。我们使用描述性统计来描述这些遭遇。
在 19071 名接受插管尝试的患者中，有 56 名（0.3%）接受了 EGD 放置。在 25 个参与站点中，有 13 个站点未报告进行 EGD 放置; 每个站点放置的 EGD 中位数为 2 个（四分位距 1-2.5，范围 1-31）。在开始气道管理之前，有 29 名（54%）患者有低血压或缺氧。临床医生报告在 55%的这些患者中预期存在困难气道，在 93%的患者中至少存在一种困难气道特征。41 次遭遇需要放置喉罩气道（LMA®）Fastrach™，其中 33 例随后通过 EGD 成功插管，7 例通过替代方法进行插管。另外 10 次遭遇使用了标准 LMA®设备。提供者在第一次插管尝试中放置了 34 个（61%）EGD。17 名 EGD 患者（30%）经历了围手术期不良事件，包括 14 名（25%）发生低氧血症。这些患者均没有因气道失败而死亡。
在这个多中心 ED 登记处，EGD 的使用很少见。EGD 主要发生在具有困难气道特征的患者中，气道管理结果良好。临床医生应该考虑为疑似困难气道的患者使用这种紧急气道设备。
