Heritage Daniel, Griggs Joanne, Barrett Jack, Clarke Scott, Carroll Rory, Lyon Richard, Bootland Duncan
University Hospital Sussex, Brighton and Hove, Brighton, UK.
Air Ambulance Charity Kent Surrey Sussex, Redhill Aerodrome, Redhill, Surrey, RH1 5YP, UK.
Scand J Trauma Resusc Emerg Med. 2024 Dec 27;32(1):138. doi: 10.1186/s13049-024-01313-y.
Early rapid sequence induction of anaesthesia (RSI) and tracheal intubation for patients with airway or ventilatory compromise following major trauma is recommended, with guidance suggesting a 45-min timeframe. Whilst on-scene RSI is recommended, the potential time benefit offered by Helicopter Emergency Medical Services (HEMS) has not been studied. We compared the time from 999/112 emergency call to delivery of RSI between patients intubated either in the Emergency Department or pre-hospital by HEMS.
A retrospective observational cohort study of major trauma patients in South-East England who received a pre-hospital RSI (PHRSI) or Emergency Department RSI (EDRSI) between 2 January 2018 and 24 September 2019. Data were extracted from the UK Trauma Audit and Research Network database. The primary outcome was the time from emergency call to delivery of RSI. Secondary outcomes included mortality at 30-days or hospital discharge, time from arrival of service at hospital or scene to RSI, time from emergency call to Computerised Tomography scan, and conveyance interval. Linear regression was used to model time to RSI in both groups.
Of 378 eligible patients, 209 patients met inclusion criteria. 103 received a PHRSI and 106 received an EDRSI. Most patients were male (n = 171, 82%) and the median age was 48 years (IQR 28-65). 94% sustained a blunt injury mechanism and head was the most injured body region for both cohorts (n = 134, 64%). 63% (n = 67) of patients receiving a PHRSI were conveyed by helicopter. PHRSI was delivered significantly earlier with a median of 64 [IQR 51-75] minutes (95% CI, 60-68) compared with EDRSI with a median of 84 [IQR 68-113] minutes (95% CI, 76-94), p < 0.001).
Major trauma patients who had a pre-hospital RSI received this time-critical intervention sooner after their injury than those who received an emergency anaesthetic after conveyance to a specialist hospital. Patient outcome benefit of HEMS delivered early RSI should be explored.
对于严重创伤后气道或通气功能受损的患者，建议早期进行快速顺序诱导麻醉（RSI）并气管插管，指南建议在45分钟内完成。虽然推荐现场进行RSI，但尚未研究直升机紧急医疗服务（HEMS）所带来的潜在时间优势。我们比较了在急诊科接受插管的患者与由HEMS在院前接受插管的患者从拨打999/112紧急电话到实施RSI的时间。
对2018年1月2日至2019年9月24日期间在英格兰东南部接受院前RSI（PHRSI）或急诊科RSI（EDRSI）的严重创伤患者进行回顾性观察队列研究。数据从英国创伤审计与研究网络数据库中提取。主要结局是从紧急电话到实施RSI的时间。次要结局包括30天或出院时的死亡率、从服务到达医院或现场到实施RSI的时间、从紧急电话到计算机断层扫描的时间以及转运间隔。采用线性回归对两组患者实施RSI的时间进行建模。
在378例符合条件的患者中，209例患者符合纳入标准。103例接受了PHRSI，106例接受了EDRSI。大多数患者为男性（n = 171，82%），中位年龄为48岁（四分位间距28 - 65岁）。94%的患者为钝性损伤机制，两个队列中头部都是受伤最严重的身体部位（n = 134，64%）。接受PHRSI的患者中有63%（n = 67）通过直升机转运。PHRSI的实施时间明显更早，中位时间为64[四分位间距51 - 75]分钟（95%置信区间，60 - 68），而EDRSI的中位时间为84[四分位间距68 - 113]分钟（95%置信区间，76 - 94），p < 0.001）。
与那些在转运到专科医院后接受紧急麻醉的患者相比，接受院前RSI的严重创伤患者在受伤后更快地接受了这一关键的时间敏感性干预措施。应探索HEMS早期实施RSI对患者结局的益处。
