院外心脏骤停患者院前早期气道干预与结局的关系：目标温度管理-2（TTM2）试验的事后分析。

Association between early airway intervention in the pre-hospital setting and outcomes in out of hospital cardiac arrest patients: A post-hoc analysis of the Target Temperature Management-2 (TTM2) trial.

机构信息

Anesthesia and Intensive Care, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Surgical Science and Integrated Diagnostics (DISC), University of Genoa, Genova, Italy.

Department of Health Sciences, University of Genoa, Genova, Italy.

出版信息

Resuscitation. 2024 Oct;203:110390. doi: 10.1016/j.resuscitation.2024.110390. Epub 2024 Sep 5.

DOI:10.1016/j.resuscitation.2024.110390

PMID:39244144

Abstract

INTRODUCTION

Airway management is a critical component of out-of-hospital cardiac arrest (OHCA) resuscitation. The primary aim of this study was to describe pre-hospital airway management in adult patients post-OHCA. Secondary aims were to investigate whether tracheal intubation (TI) versus use of supraglottic airway device (SGA) was associated with patients' outcomes, including ventilator-free days within 26 days of randomization, 6 months neurological outcome and mortality.

METHODS

Secondary analysis of the Target Temperature Management-2 (TTM2) trial conducted in 13 countries, including adult patients with OHCA and return of spontaneous circulation, with data available on pre-hospital airway management. A multivariate logistic regression model with backward stepwise selection was employed to assess whether TI versus SGA was associated with outcomes.

RESULTS

Of the 1900 TTM2 trial patients, 1702 patients (89.5%) were included, with a mean age of 64 years (Standard Deviation, SD = 13.53); 79.1% were males. Pre-hospital airway management was SGA in 484 (28.4%), and TI in 1218 (71.6%) patients. At hospital admission, 87.8% of patients with SGA and 98.5% with TI were mechanically ventilated (p < 0.001). In the multivariate analysis, TI in comparison with SGA was not independently associated with an increase in ventilator-free days within 26 days of randomization, improved neurological outcomes, or decreased mortality. The hazard ratio for mortality with TI vs. SGA was 1.06, 95%Confidence Interval (CI) 0.88-1.28, p = 0.54.

CONCLUSIONS

In the multicentre randomized TTM2-trial including patients with OHCA, most patients received prehospital endotracheal intubation to manage their airway. The choice of pre-hospital airway device was not independently associated with patient clinical outcomes.

TRIAL REGISTRATION NUMBER

NCT02908308.

摘要

介绍

气道管理是院外心脏骤停（OHCA）复苏的一个关键组成部分。本研究的主要目的是描述 OHCA 后成年患者的院前气道管理。次要目的是研究气管插管（TI）与使用声门上气道装置（SGA）是否与患者的预后相关，包括随机分组后 26 天内无呼吸机天数、6 个月的神经功能结局和死亡率。

方法

在 13 个国家进行的目标温度管理-2（TTM2）试验的二次分析，纳入 OHCA 并恢复自主循环的成年患者，且有院前气道管理的数据。采用向后逐步选择的多变量逻辑回归模型来评估 TI 与 SGA 是否与结局相关。

结果

在 1900 例 TTM2 试验患者中，纳入了 1702 例患者（89.5%），平均年龄为 64 岁（标准差[SD]为 13.53）；79.1%为男性。院前气道管理中，484 例患者使用 SGA（28.4%），1218 例患者使用 TI（71.6%）。入院时，使用 SGA 的患者中有 87.8%，使用 TI 的患者中有 98.5%接受了机械通气（p < 0.001）。多变量分析中，与 SGA 相比，TI 并不独立增加随机分组后 26 天内无呼吸机天数、改善神经功能结局或降低死亡率。与 SGA 相比，TI 死亡率的危险比为 1.06，95%置信区间（CI）为 0.88-1.28，p = 0.54。