Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA.
Department of Anesthesiology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Am J Emerg Med. 2024 Nov;85:48-51. doi: 10.1016/j.ajem.2024.08.032. Epub 2024 Aug 24.
Airway management is a key intervention during the resuscitation of critically ill trauma patients. Emergency surgical airway (ESA) placement is taught as a backup option when endotracheal intubation (ETI) fails. We sought to (1) describe the incidence of the emergency department (ED) ESA, (2) compare ESA versus ETI-only recipients, and (3) determine which factors were associated with receipt of an ESA.
We searched within the Trauma Quality Improvement Program datasets from 2017 to 2022 for all emergency department surgical airway placement and/or endotracheal intubations recipients. We compared ESA versus ETI-only recipients.
From 2017 to 2022, there were 6,477,759 within the datasets, of which 238,128 met inclusion for this analysis. Within that, there were 236,292 ETIs, 2264 ESAs, with 428 (<1 %) having documentation of both. Of the ESAs performed, there were 82 documented in children <15 years of age with the youngest being 1 year of age. The ETI-only group had a lower proportion serious injuries to the head/neck (52 % versus 59 %), face (2 % versus 8 %), and skin (3 % versus 6 %). However, the ETI-only group had a higher proportion of serious injuries to the abdomen (15 % versus 9 %) and the extremities (19 % versus 12 %). Survival at 24-h was higher in the ETI-only group (83 % versus 76 %) as well as survival to discharge (70 % versus 67 %). In the subanaysis of children <15 years (n = 82), 34 % occurred in the 1-4 years age group, 35 % in the 5-9 years age group, and 30 % in the 10-14 years age group. In our multivariable logistic regression analysis, serious injuries to the head/neck (odds ratio [OR] 1.37, 95 % CI 1.23-1.54), face (OR 3.41, 2.83-4.11), thorax (OR 1.19, 1.06-1.33), and skin (OR 1.53, 1.15-2.05) were all associated with receipt of cricothyrotomy. Firearm (OR 3.62, 3.18-4.12), stabbing (2.85, 2.09-3.89), and other (OR 2.85, 2.09-3.89) were associated with receipt of ESA when using collision as the reference variable.
ESA placement is a rarely performed procedure but frequently used as a primary airway intervention in this dataset. Penetrating mechanisms, and injuries to face were most associated with ESA placement. Our findings reinforce the need to maintain this critical airway skill for trauma management.
气道管理是危重症创伤患者复苏的关键干预措施。当气管插管（ETI）失败时，紧急外科气道（ESA）的放置被作为后备选择进行教学。我们旨在：（1）描述急诊科（ED）ESA 的发生率；（2）比较 ESA 与仅接受 ETI 的患者；（3）确定哪些因素与接受 ESA 有关。
我们在 2017 年至 2022 年的创伤质量改进计划数据集内搜索所有接受紧急外科气道放置和/或气管插管的患者。我们比较了 ESA 与仅接受 ETI 的患者。
在 2017 年至 2022 年的数据集中，共有 6477759 例患者，其中有 238128 例符合本分析的纳入标准。在这其中，有 236292 例 ETI，2264 例 ESA，有 428 例（<1%）有两者的记录。在进行的 ESA 中，有 82 例记录在 15 岁以下的儿童中，年龄最小的为 1 岁。仅接受 ETI 的患者中，头部/颈部（52%对 59%）、面部（2%对 8%）和皮肤（3%对 6%）严重损伤的比例较低。然而，仅接受 ETI 的患者中，腹部（15%对 9%）和四肢（19%对 12%）严重损伤的比例较高。24 小时生存率在仅接受 ETI 的患者中更高（83%对 76%），出院生存率也更高（70%对 67%）。在<15 岁儿童的亚组分析中（n=82），34%发生在 1-4 岁年龄组，35%发生在 5-9 岁年龄组，30%发生在 10-14 岁年龄组。在我们的多变量逻辑回归分析中，头部/颈部（比值比 [OR] 1.37，95%置信区间 [CI] 1.23-1.54）、面部（OR 3.41，2.83-4.11）、胸部（OR 1.19，1.06-1.33）和皮肤（OR 1.53，1.15-2.05）严重损伤均与环甲切开术的实施有关。火器伤（OR 3.62，3.18-4.12）、刺伤（2.85，2.09-3.89）和其他（OR 2.85，2.09-3.89）与使用碰撞作为参考变量时接受 ESA 有关。
ESA 放置是一种很少进行的操作，但在本数据集中经常作为主要气道干预措施使用。穿透性机制和面部损伤与 ESA 放置最相关。我们的发现强调了在创伤管理中保持这种关键气道技能的必要性。
