Bierowski Abagayle E, Comber Paul C, Kuc Alexander, Shah Aman, Carroll Gerard
Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PennsylvaniaUSA.
Department of Emergency Medicine, Cooper University Hospital, Camden, New JerseyUSA.
Prehosp Disaster Med. 2025 Apr;40(2):73-76. doi: 10.1017/S1049023X25000238. Epub 2025 Apr 2.
Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers' first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.
This study's aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.
This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 ( = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at < .05.
Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; < .001) and 2021 (n = 87; 70.7%; < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; = .0072).
Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency's decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers' proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.
许多紧急医疗服务（EMS）机构在新冠疫情高峰期修改了其协议，特别是那些涉及会增加空气传播暴露风险的操作的协议，如插管。2020年，当地高级生命支持（ALS）提供者的一线气道管理设备是声门上气道（SGA），气管插管（TI）很少进行。
本研究的目的是调查这一与疫情相关的协议变更对首次TI成功率和总体初始高级气道放置成功率的潜在临床影响。
本研究是一项对来自单个城市EMS机构的所有ALS出诊记录的回顾性研究，这些出诊导致在2019年1月1日至2021年6月30日期间每次出诊至少放置一个高级气道（n = 452）。使用描述性统计和卡方检验来评估数据。统计学显著性定义为P <.05。
与2019年（n = 80；P <.001）相比，2020年尝试的TI显著减少（n = 16），与2019年（n = 63；78.8%；P =.047）相比，2021年首次TI成功率显著下降（n = 22；61.1%）。此外，2020年SGA放置占所有初始气道管理尝试的91.2%（n = 165），高于2019年（n = 114；58.8%；P <.001）和2021年（n = 87；70.7%；P <.001）。包括声门上气道和TI在内的总体首次高级气道放置成功率从2019年（n = 169；87.1%）提高到2020年（n = 170；93.9%；P =.025）。相反，总体首次高级气道放置成功率从2020年到2021年下降（n = 104；84.6%；P =.0072）。
在新冠疫情期间缺乏TI操作的机会可能导致了该当地机构在2021年首次TI成功率下降。展望未来，各机构应利用模拟实验室和其他继续教育措施，帮助维持院前急救人员执行这一关键操作的熟练度，特别是当协议变更暂时阻碍或禁止基于现场的心理运动技能发展时。
