Essex & Herts Air Ambulance Trust, Essex, UK.
Imperial College London, London, UK.
Scand J Trauma Resusc Emerg Med. 2024 Feb 12;32(1):12. doi: 10.1186/s13049-024-01183-4.
Pre-Hospital Emergency Anaesthesia (PHEA) has undergone significant developments since its inception. However, optimal drug dosing remains a challenge for both medical and trauma patients. Many prehospital teams have adopted a drug regimen of 3 mcg/kg fentanyl, 2 mg/kg ketamine and 1 mg/kg rocuronium ('3:2:1'). At Essex and Herts Air Ambulance Trust (EHAAT) a new standard dosing regimen was introduced in August 2021: 1 mcg/kg fentanyl, 2 mg/kg ketamine and 2 mg/kg rocuronium (up to a maximum dose of 150 mg) ('1:2:2'). The aim of this study was to evaluate the cardiorespiratory consequences of a new attenuated fentanyl and augmented rocuronium dosing regimen.
A retrospective study was conducted at EHAAT as a service evaluation. Anonymized records were reviewed from an electronic database to compare the original ('3:2:1') drug dosing regimen (December 2019-July 2021) and the new ('1:2:2') dosing regimen (September 2021-May 2023). The primary outcome was the incidence of absolute hypotension within ten minutes of induction. Secondary outcomes included immediate hypertension, immediate hypoxia and first pass success (FPS) rates.
Following exclusions (n = 121), 720 PHEA cases were analysed (360 new vs. 360 original, no statistically significant difference in demographics). There was no difference in the rate of absolute hypotension (24.4% '1:2:2' v 23.8% '3:2:1', p = 0.93). In trauma patients, there was an increased first pass success (FPS) rate with the new regimen (95.1% v 86.5%, p = 0.01) and a reduced incidence of immediate hypoxia (7.9% v 14.8%, p = 0.05). There was no increase in immediate hypertensive episodes (22.7% vs. 24.2%, p = 0.73). No safety concerns were identified.
An attenuated fentanyl and augmented rocuronium dosing regimen showed no difference in absolute hypotensive episodes in a mixed cohort of medical and trauma patients. In trauma patients, the new regimen was associated with an increased FPS rate and reduced episodes of immediate hypoxia. Further research is required to understand the impact of such drug dosing in the most critically ill and injured subpopulation.
自创立以来，院前急救麻醉（PHEA）已经取得了重大发展。然而，对于内科和创伤患者来说，最佳的药物剂量仍然是一个挑战。许多院前急救队伍采用了 3 mcg/kg 芬太尼、2 mg/kg 氯胺酮和 1 mg/kg 罗库溴铵的药物方案（“3:2:1”）。在埃塞克斯和赫特福德郡空中救护信托基金（EHAAT），自 2021 年 8 月起引入了新的标准剂量方案：1 mcg/kg 芬太尼、2 mg/kg 氯胺酮和 2 mg/kg 罗库溴铵（最大剂量为 150 mg）（“1:2:2”）。本研究旨在评估一种新的芬太尼衰减和罗库溴铵增强剂量方案对心肺的影响。
这是一项在 EHAAT 进行的回顾性研究，作为服务评估。从电子数据库中审查匿名记录，以比较原始（“3:2:1”）药物剂量方案（2019 年 12 月至 2021 年 7 月）和新方案（“1:2:2”）（2021 年 9 月至 2023 年 5 月）。主要结局是诱导后十分钟内绝对低血压的发生率。次要结局包括即刻高血压、即刻低氧血症和首次通过成功率（FPS）。
排除（n=121）后，分析了 720 例 PHEA 病例（新方案 360 例，原始方案 360 例，两组人群的人口统计学特征无统计学差异）。绝对低血压的发生率无差异（新方案 24.4%，原始方案 23.8%，p=0.93）。在创伤患者中，新方案的首次通过成功率更高（95.1%比 86.5%，p=0.01），即刻低氧血症的发生率更低（7.9%比 14.8%，p=0.05）。即刻高血压发作的发生率没有增加（22.7%比 24.2%，p=0.73）。未发现安全问题。
在混合内科和创伤患者队列中，芬太尼衰减和罗库溴铵增强剂量方案在绝对低血压发作方面无差异。在创伤患者中，新方案与更高的 FPS 率和即刻低氧血症发作减少相关。需要进一步研究来了解这种药物剂量在最危重和受伤的亚群中的影响。
