Kibblewhite Chris, Todd Verity F, Howie Graham, Sanders Josh, Ellis Craig, Dittmer Bryan, Garcia Elena, Swain Andy, Smith Tony, Dicker Bridget
Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand.
Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand.
Resusc Plus. 2023 Jul 28;15:100432. doi: 10.1016/j.resplu.2023.100432. eCollection 2023 Sep.
Airway management is crucial for emergency care in critically ill patients outside the hospital setting. An Airway Registry is useful in providing essential information for quality improvement purposes. Therefore, this study aimed to develop an out-of-hospital airway registry and describe airway management practices in Aotearoa New Zealand (AoNZ).
Data from the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) database were used in a retrospective cohort study covering July 2020 to June 2021. All patients receiving airway interventions were included. An airway intervention was defined as one or more of the following: non-drug assisted endotracheal intubation (NDA-ETI), drug-assisted endotracheal intubation (DA-ETI; where a combination of paralytic agent and sedative were used to aid in intubation), laryngeal mask airway (LMA), oropharyngeal airway (OPA), nasopharyngeal airway (NPA), surgical airway (cricothyroidotomy), suction, jaw thrust. Descriptive statistics were analysed using Chi-Square and logistic regression modelling investigated the relationship between advanced airway success and patient characteristics.
The study included 4,529 patients who underwent 7,779 airway interventions. Basic airway interventions were used most frequently: OPA (45.1%), NPA (29.3%), LMA (28.9%), suction (19.9%) and jaw thrust (17.6%). Advanced airway interventions were used less frequently: NDA-ETI (19.8%), DA-ETI (8.7%), and surgical airways (0.2%). The success rate for ETI (including both NDA-ETI and DA-ETI) was 89.4%, with NDA-ETI success at 85.8% and DA-ETI success at 97.7%. ETI first-pass success rates were significantly lower for males (aOR 0.65, 95%CI 0.48-0.87, < 0.001) and higher for non-cardiac arrest injury patients (aOR 2.94, 95%CI 1.43-6.00, < 0.001). In this cohort receiving airway interventions the 1-day mortality rate was 41.1%, demonstrating that a high proportion of these patients were severely clinically compromised.
Out-of-hospital airway management practices and success rates in AoNZ are comparable to those elsewhere. This research has determined the variables to be used as the AoNZ Paramedic Airway Registry ongoing and has demonstrated baseline outcomes in airway management for ongoing quality improvement using this registry.
气道管理对于院外危重症患者的急救护理至关重要。气道登记册有助于提供质量改进所需的基本信息。因此，本研究旨在建立一个院外气道登记册，并描述新西兰（AoNZ）的气道管理实践。
在一项回顾性队列研究中使用了新西兰护理人员护理收集（ANZPaCC）数据库2020年7月至2021年6月的数据。纳入所有接受气道干预的患者。气道干预定义为以下一项或多项：非药物辅助气管插管（NDA-ETI）、药物辅助气管插管（DA-ETI；使用麻痹剂和镇静剂组合辅助插管）、喉罩气道（LMA）、口咽气道（OPA）、鼻咽气道（NPA）、手术气道（环甲膜切开术）、吸引、下颌前推。使用卡方分析描述性统计数据，并采用逻辑回归模型研究高级气道成功与患者特征之间的关系。
该研究纳入了4529例接受7779次气道干预的患者。最常使用的是基本气道干预措施：OPA（45.1%）、NPA（29.3%）、LMA（28.9%）、吸引（19.9%）和下颌前推（17.6%）。较少使用高级气道干预措施：NDA-ETI（19.8%）、DA-ETI（8.7%）和手术气道（0.2%）。气管插管（包括NDA-ETI和DA-ETI）的成功率为89.4%，NDA-ETI成功率为85.8%，DA-ETI成功率为97.7%。男性的气管插管首次通过成功率显著较低（校正比值比0.65，95%置信区间0.48-0.87，<0.001），非心脏骤停损伤患者的成功率较高（校正比值比2.94，95%置信区间1.43-6.00，<0.001）。在这个接受气道干预的队列中，1天死亡率为41.1%，表明这些患者中有很大比例在临床上严重受损。
新西兰的院外气道管理实践和成功率与其他地方相当。本研究确定了用作持续的新西兰护理人员气道登记册的变量，并展示了使用该登记册进行持续质量改进的气道管理基线结果。
