Department of Emergency Medicine, The Ohio State University, Columbus.
Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus.
JAMA Netw Open. 2024 Aug 1;7(8):e2427763. doi: 10.1001/jamanetworkopen.2024.27763.
Identifying longitudinal changes in advanced airway management by emergency medical services (EMS) is crucial for understanding practice patterns and optimizing care.
To examine the longitudinal trends in endotracheal intubation (ETI) and supraglottic airway (SGA) utilization in a national EMS cohort.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cross-sectional study analyzed 2011 to 2022 data from the ESO Data Collaborative, a national database of US prehospital electronic health records. The study included all 911 EMS events in which advanced airway management was attempted. Data were analyzed from November 2022 to January 2024.
Advanced airway management attempts, including ETI, SGA, and surgical airways.
The annual percentage of ETI and SGA attempts, stratified by underlying condition (cardiac arrest, nonarrest medical, nonarrest trauma, pediatrics).
Among 47.5 million EMS activations, 444 041 (mean [SD] age, 60.6 [19.8] years; 273 296 [61.5%] men) involved advanced airway management, including 305 584 (68.8%) that used ETI and 200 437 (45.1%) that used SGA. The overall incidence was 9.3 per 1000 EMS events. In the cardiac arrest cohort from 2011 to 2022, EMS events with ETI attempts decreased from 2470 of 2831 (87.3%) to 40 083 of 72 793 (55.1%) and those with SGA attempts increased from 711 of 2831 (25.1%) to 44 386 of 72 793 (61.0%). In the pediatric subset, there were similarly large decreases in ETI attempts, from 117 of 182 EMS events (97.3%) to 1573 of 2307 EMS events (68.2%), and increases in SGA attempts, from 11 of 182 EMS events (6.6%) to 1058 of 2307 EMS events (45.9%). In the nonarrest medical and nonarrest trauma cohorts, ETI attempts decreased and SGA attempts increased but to a much lower extent.
In this national cross-sectional study of EMS care episodes, there were marked shifts in advanced airway management practices, with the increased use of SGA and decreased use of ETI. These observations highlight current trends in EMS airway management practices.
识别急救医疗服务 (EMS) 中高级气道管理的纵向变化对于了解实践模式和优化护理至关重要。
在全国性的 EMS 队列中研究气管内插管 (ETI) 和声门上气道 (SGA) 使用的纵向趋势。
设计、设置和参与者：这项回顾性的横断面研究分析了来自 ESO Data Collaborative的 2011 年至 2022 年的数据，该数据库是美国院前电子健康记录的全国性数据库。该研究纳入了所有尝试进行高级气道管理的 911 个 EMS 事件。数据分析于 2022 年 11 月至 2024 年 1 月进行。
高级气道管理尝试，包括 ETI、SGA 和手术气道。
按潜在情况（心脏骤停、非心脏骤停医学、非心脏骤停创伤、儿科）分层的 ETI 和 SGA 尝试的年度百分比。
在 4750 万次 EMS 激活中，444041 次（平均[标准差]年龄为 60.6[19.8]岁；273296[61.5%]为男性）涉及高级气道管理，其中 305584 次（68.8%）使用 ETI，200437 次（45.1%）使用 SGA。总体发生率为每 1000 次 EMS 事件 9.3 次。在 2011 年至 2022 年的心脏骤停队列中，进行 ETI 尝试的 EMS 事件从 2831 次中的 2470 次（87.3%）减少到 72793 次中的 40083 次（55.1%），而进行 SGA 尝试的 EMS 事件从 2831 次中的 711 次增加到 72793 次中的 44386 次（61.0%）。在儿科亚组中，ETI 尝试的降幅同样很大，从 182 次 EMS 事件中的 117 次（97.3%）减少到 2307 次 EMS 事件中的 1573 次（68.2%），SGA 尝试的增幅从 182 次 EMS 事件中的 11 次（6.6%）增加到 2307 次 EMS 事件中的 1058 次（45.9%）。在非心脏骤停医学和非心脏骤停创伤队列中，ETI 尝试减少，SGA 尝试增加，但程度要低得多。
在这项针对 EMS 护理事件的全国性横断面研究中，高级气道管理实践发生了明显转变，SGA 的使用增加，ETI 的使用减少。这些观察结果突出了当前 EMS 气道管理实践的趋势。
