Humar Matthew, Meadley Benjamin, Cresswell Bart, Nehme Emily, Groombridge Christopher, Anderson David, Nehme Ziad
Ambulance Victoria, 375 Manningham Rd, Doncaster, Melbourne, Victoria 3108, Australia.
Department of Paramedicine, Monash University, Level 2, Building H, Peninsula Campus, 47-49 Moorooduc Hwy, Frankston, Victoria 3199, Australia.
Resusc Plus. 2024 Nov 26;20:100833. doi: 10.1016/j.resplu.2024.100833. eCollection 2024 Dec.
To describe the incidence, characteristics, success rates, and outcomes of out-of-hospital cardiac arrest (OHCA) patients receiving cricothyroidotomy.
Over an 18-year period, we retrospectively analysed patient care records and cardiac arrest registry data for cricothyroidotomy cases. Multivariable logistic regression analysis was used to examine associations between study characteristics and cricothyroidotomy success.
We identified 80 cricothyroidotomies, 56 of which occurred in OHCA. The incidence of cricothyroidotomy in OHCA was 1.1 per 1,000 attempted resuscitations and increased over the study period (incidence rate ratio [IRR] = 1.13, 95 % confidence interval [CI]: 1.02-1.25, p = 0.023). The overall success rate was 68.8 % (n = 55/80), with lower success in cardiac arrest (n = 33/56, 58.9 %) than non-cardiac arrest patients (n = 22/24, 91.7 %). In OHCA, success rates were higher for surgical compared to needle techniques (88.2 % vs. 54.6 %, p = 0.003). Cardiac arrest (odds ratio [OR] 0.09, 95 % CI 0.16-0.51) and needle techniques (OR 0.11, 95 % CI 0.02-0.56) were independently associated with lower odds of procedural success, while male sex (OR 10.06, 95 % CI 2.00-50.62) was associated with higher odds. Return of spontaneous circulation occurred in 44.6 % (n = 22/56), with 35.7 % (n = 20/56) surviving to hospital and 7.1 % (n = 4/56) surviving to hospital discharge. Procedural complications included cardiac arrest (n = 6/56, 10.7 %), minor bleeding (n = 5/56, 8.9 %), surgical emphysema (n = 3/56, 5.4 %), and major bleeding (n = 2/56, 3.6 %).
We found cricothyroidotomy in OHCA to be associated with low rates of procedural success and high mortality rates. Further studies are required to assess the role and potential benefits of cricothyroidotomy in cardiac arrest.
描述接受环甲膜切开术的院外心脏骤停（OHCA）患者的发生率、特征、成功率及结局。
在18年期间，我们回顾性分析了环甲膜切开术病例的患者护理记录和心脏骤停登记数据。采用多变量逻辑回归分析来检验研究特征与环甲膜切开术成功之间的关联。
我们确定了80例环甲膜切开术，其中56例发生在OHCA患者中。OHCA中环甲膜切开术的发生率为每1000次复苏尝试中有1.1例，且在研究期间有所增加（发生率比[IRR]=1.13，95%置信区间[CI]：1.02-1.25，p=0.023）。总体成功率为68.8%（n=55/80），心脏骤停患者的成功率（n=33/56，58.9%）低于非心脏骤停患者（n=22/24，91.7%）。在OHCA中，手术技术的成功率高于针穿刺技术（88.2%对54.6%，p=0.003）。心脏骤停（优势比[OR]0.09，95%CI 0.16-0.51）和针穿刺技术（OR 0.11，95%CI 0.02-0.56）与手术成功几率较低独立相关，而男性（OR 10.06，95%CI 2.00-50.62）与较高的成功几率相关。自主循环恢复率为44.6%（n=22/56），35.7%（n=20/56）存活至入院，7.1%（n=4/56）存活至出院。手术并发症包括心脏骤停（n=6/56，10.7%）、轻微出血（n=5/56，8.9%）、手术性气肿（n=3/56，5.4%）和大出血（n=2/56，3.6%）。
我们发现OHCA中的环甲膜切开术与手术成功率低和死亡率高相关。需要进一步研究来评估环甲膜切开术在心脏骤停中的作用和潜在益处。
