Thames Valley Air Ambulance, Stokenchurch House, Oxford Road, Stokenchurch, HP14 3SX, UK.
BMC Emerg Med. 2023 Oct 31;23(1):126. doi: 10.1186/s12873-023-00897-5.
Pre-hospital emergency anaesthesia is a critical intervention undertaken by helicopter emergency medical teams. Previous studies informed current practice for induction regimes, using a standardized approach of fentanyl, ketamine and rocuronium. There may be a trend towards post-induction hypotension attributed to the induction regime used. Several new combinations of fentanyl, ketamine and rocuronium are emerging in clinical practice. There is currently no consensus on what induction regimes should be used.
A semi-structured survey was distributed to the medical leads of all UK air ambulance organisations between December 2022 and February 2023. Responses that were returned within the study period were included. Exclusions included missing data, declined participation and failure to return the survey within the data collection period. The survey sought to establish provision of pre-hospital emergency anaesthesia and current induction regimes for stable, unstable and post-cardiac arrest patients. Data was extracted from Microsoft Forms into Excel. Descriptive statistics were used to analyse survey response rate, provision of PHEA and induction regimes. The survey was endorsed by the National HEMS Research and Audit Forum.
19 air ambulance organisations responded (response rate 86%). The majority of organisations provide over 100 pre-hospital emergency anaesthetics per annum (79%, n = 15/19). A standard combination of fentanyl, ketamine and rocuronium is used as a primary induction regime in haemodynamically stable patients by 52% of services (n = 10/19). In haemodynamically compromised patients, fentanyl was omitted or pracititioner choice emphasized by 79% of services (n = 15/19). There was variability in the dose of rocuronium from 1 mg/kg to 2 mg/kg throughout services.
There is variability in the approach to pre-hospital emergency anaesthesia. There is a growing dataset that would enable development of a registry to better understand induction regimes and the impact on patient physiology. Organisations are increasingly adopting a patient centered, practitioner choice model towards induction of anaesthesia.
直升机紧急医疗团队进行的院前急救麻醉是一项关键干预措施。以前的研究为诱导方案提供了当前实践的信息，使用芬太尼、氯胺酮和罗库溴铵的标准化方法。由于使用的诱导方案，可能存在诱导后低血压的趋势。几种新的芬太尼、氯胺酮和罗库溴铵组合正在临床实践中出现。目前，对于应该使用哪些诱导方案还没有共识。
2022 年 12 月至 2023 年 2 月期间，向英国所有空中救护组织的医疗负责人分发了一份半结构式调查。在研究期间内回复的调查结果被包括在内。排除了数据缺失、拒绝参与和未在数据收集期内回复调查的情况。该调查旨在确定院前急救麻醉的提供情况以及稳定、不稳定和心脏骤停后患者的当前诱导方案。数据从 Microsoft Forms 中提取到 Excel 中。使用描述性统计分析来分析调查的回复率、PHEA 的提供情况和诱导方案。该调查得到了国家 HEMS 研究和审计论坛的认可。
19 家空中救护组织做出了回应（回复率为 86%）。大多数组织每年提供超过 100 次院前急救麻醉（79%，n=19/19）。52%的服务机构（n=19/19）将芬太尼、氯胺酮和罗库溴铵的标准组合作为血流动力学稳定患者的主要诱导方案。在血流动力学受损的患者中，79%的服务机构（n=19/19）省略了芬太尼或强调了医生的选择。整个服务机构罗库溴铵的剂量从 1mg/kg 到 2mg/kg 不等。
院前急救麻醉的方法存在差异。有越来越多的数据集可以用来开发一个登记处，以更好地了解诱导方案及其对患者生理的影响。各组织越来越倾向于采用以患者为中心、医生选择的模式来诱导麻醉。
