Saviluoto Anssi, Setälä Piritta, Tommila Miretta, Pirneskoski Jussi, Raatiniemi Lasse, Nurmi Jouni
Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, FinnHEMS 10, Vesikuja 9, Helsinki, Vantaa, 01530, Finland.
Centre for Prehospital Emergency Care, Helicopter Emergency Medical Services, Tampere University Hospital, Tampere, Finland.
Scand J Trauma Resusc Emerg Med. 2025 May 30;33(1):98. doi: 10.1186/s13049-025-01412-4.
Prehospital anaesthesia is a challenging procedure, and the outcome depends on the quality of the process. Hospital-acquired anaesthesia experience does not necessarily translate to high performance in the prehospital setting. We aimed to assess the quality and practice patterns in prehospital anaesthesia related to cumulative experience amongst new prehospital critical care physicians. In this study, we aimed to evaluate whether quality indicators for prehospital anaesthesia and related mortality improve as new prehospital critical care physicians become more experienced with this intervention.
We conducted a registry-based observational study including all patients who underwent anaesthesia and airway management by physicians who started working in the national HEMS between January 2013 and August 2019. Patients were grouped and compared based on the provider's cumulative case volume at the time of the mission: 1-10, 11-20, 21-40, 41-80 and > 80 cases. The association between cumulative experience and 30-day mortality was assessed using multivariate logistic regression analysis. Secondary outcomes included first-pass intubation success, post-intubation hypoxia and hypotension, the combined use of a neuromuscular blocking agent and anaesthetic, on-scene time, mechanical ventilation usage, and rates of normocapnia, hypoxia, and hypotension at handover.
1,638 patients (median age 59, 64% male) were treated by 32 physicians. Median on-scene time decreased with increasing experience from 33 (interquartile range [IQR] 23-44) to 28 (IQR 19-38) minutes, P = 0.03. Higher experience was associated with increased use of mechanical ventilation (P < 0.001) and a combination of neuromuscular blocking agents and anaesthetics (P = 0.03). Other secondary outcomes did not show a statistically significant difference between the groups. Crude mortality decreased from 38 to 26% in the lowest to highest experience groups. In the multivariate logistic regression analysis, the same trend was still seen with the odds ratio of the highest experience group for 30-day mortality 0.59 (95% CI 0.38-0.94, lowest experience group as a reference).
In a prehospital critical care service, outcomes improve after a high number of prehospital cases, even when physicians with a solid foundation in in-hospital anaesthesia are employed. Limiting physician turnover may improve the quality of care.
院前麻醉是一项具有挑战性的操作，其结果取决于操作过程的质量。医院获得的麻醉经验不一定能转化为院前环境中的高效表现。我们旨在评估新的院前重症医生在院前麻醉方面的质量和实践模式与累积经验的关系。在本研究中，我们旨在评估随着新的院前重症医生对该干预措施的经验增加，院前麻醉的质量指标和相关死亡率是否会得到改善。
我们进行了一项基于登记的观察性研究，纳入了2013年1月至2019年8月期间开始在国家直升机紧急医疗服务（HEMS）工作的医生进行麻醉和气道管理的所有患者。根据任务执行时提供者的累积病例数将患者分组并进行比较：1 - 10例、11 - 20例、21 - 40例、41 - 80例和>80例。使用多因素逻辑回归分析评估累积经验与30天死亡率之间的关联。次要结局包括首次插管成功率、插管后低氧血症和低血压、神经肌肉阻滞剂和麻醉剂的联合使用、现场时间、机械通气使用情况以及交接时的正常二氧化碳血症、低氧血症和低血压发生率。
32名医生治疗了1638例患者（中位年龄59岁，64%为男性）。随着经验增加，中位现场时间从33（四分位间距[IQR]23 - 44）分钟降至28（IQR 19 - 38）分钟，P = 0.03。经验增加与机械通气使用增加（P < 0.001）以及神经肌肉阻滞剂和麻醉剂联合使用增加（P = 0.03）相关。其他次要结局在各组之间未显示出统计学显著差异。最低经验组至最高经验组的粗死亡率从38%降至26%。在多因素逻辑回归分析中，最高经验组30天死亡率的比值比仍呈现相同趋势，为0.59（95%CI 0.38 - 0.94，以最低经验组为参照）。
在院前重症服务中，即使雇佣了在院内麻醉方面有坚实基础的医生，大量院前病例后结局仍会改善。限制医生更替可能会提高护理质量。
