Rödler Jana Vienna, Hilgers Sabrina, Rüppel Marc, Föhr Philipp, Hohn Andreas, Chorianopoulos Emmanuel, Bergrath Sebastian
Zentrum für klinische Akut- und Notfallmedizin, Kliniken Maria Hilf, Akademisches Lehrkrankenhaus der RWTH Aachen, Viersener Straße 450, 41063, Mönchengladbach, Deutschland.
Lehrstuhl für Anästhesiologie, Medizinische Fakultät der RWTH Aachen, Aachen, Deutschland.
Anaesthesiologie. 2024 Aug;73(8):511-520. doi: 10.1007/s00101-024-01444-y. Epub 2024 Aug 2.
Securing the airway in the emergency department (ED) is a high-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was a retrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications.
Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent a six-week training program including a two-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with a placed laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate.
During the study period 499 patients were intubated by the core ED team and 28 patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527 (2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08).
In clinical acute and emergency medicine, a standardized approach utilizing video laryngoscopy and a bougie following a structured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting.
在急诊科确保气道安全是一项高风险操作；然而，在德国，其首次成功率和并发症发生率在很大程度上尚不清楚。本研究的目的是对前瞻性收集的复苏室气管插管（ETI）数据进行回顾性分析，内容涉及适应证、操作过程及并发症。
在伦理委员会批准（EK 23 - 369）后，对2020年1月1日至2023年6月30日期间在德国门兴格拉德巴赫玛利亚希尔夫医院急诊科进行的所有ETI操作进行分析。排除麻醉科进行的首次插管操作。急诊科的核心医疗团队在急诊科进行ETI操作前，接受了为期六周的培训项目，其中包括为期两周的麻醉轮转。对于快速顺序诱导（RSI）和使用视频喉镜（C-Mac，史托斯）放置喉罩（LT）后进行气道交换均有标准操作规程（SOP），使用罗库溴铵进行肌肉松弛，并使用弹性探条进行首次插管。分析首次成功率、总体成功率及插管相关并发症。此外，还评估了急诊科顾问人员和住院医师因素对首次成功率的影响。
在研究期间，急诊科核心团队对499例患者进行了插管，28例患者从LT转换为ETI进行气道交换。489/499例（98.0%）ETI操作和25/28例（89.3%）LT转换患者实现了首次成功。在无法插管的情况下，5/527例（0.9%）患者通过手术确保了气道安全，11/527例（2.2%）患者在ETI操作数分钟后发生心脏骤停。气管导管置入的总体首次通过成功率为514/527例（97.4%）。顾问人员的首次成功率（168/175；96.0%）与住院医师的首次成功率（320/325；98.5%）比较，差异无统计学意义（p = 0.08）。
在临床急性和急诊医学中，在院内环境下，对于危重症急诊患者这一高风险群体，采用视频喉镜和探条的标准化方法，并遵循结构化培训理念，可实现高于平均水平的高首次成功率，同时严重并发症发生率较低。
