Cantineau J P, Tazarourte K, Merckx P, Martin L, Reynaud P, Berson C, Bertrand C, Aussavy F, Lepresle E, Pentier C, Duvaldestin P
CHU Henri-Mondor, Assistance publique-hôpitaux de Paris, Créteil, France.
Ann Fr Anesth Reanim. 1997;16(7):878-84. doi: 10.1016/s0750-7658(97)89837-1.
To investigate complications of emergency endotracheal intubation (EEI), possibly facilitated by rapid-sequence induction, in the prehospital critical care setting: 1) the difficulty of intubation; 2) the cardiorespiratory consequences of intubation; 3) the relationship between the occurrence of complications and prognosis.
Prospective non randomized, open study.
All patients treated over a 5-month period by a physician-manned ambulance service and requiring EEI.
Patients were allocated either in with cardiac arrest (CA) group or a group with maintained spontaneous circulation (SC). Difficulty of intubation was assessed by the number of attempts.
Two hundred and twenty-four consecutive EEI were carried out by physicians (46%) and residents (38%) not trained in anaesthesia, anaesthetists (8%), or nurse anaesthetists (7%). Trachea was intubated after a maximum of three attempts in all patients. Success rate at the first attempt was 91%. It was 92% in CA patients (n = 76) and 90% in SC patients (P = 0.59). Anaesthetic induction, with (n = 112) or without (n = 12) succinylcholine, was used to facilitate 84% of intubations in SC patients. Complications occurred in 30 patients (20%). There was no relationship between the latter and hospital mortality, duration of ventilatory support, duration of stay in the intensive care unit.
In this study, EEI in SC patients was frequently facilitated by rapid sequence induction and was associated with a high success rate at the first attempt, as in CA patients. Morbidity was low. All physicians involved in emergency airway management should be skilled in this technique.
调查在院前重症监护环境中，可能因快速序贯诱导而促进的紧急气管插管（EEI）的并发症：1）插管困难；2）插管的心肺后果；3）并发症的发生与预后之间的关系。
前瞻性非随机、开放性研究。
在5个月期间由配备医生的救护车服务治疗且需要紧急气管插管的所有患者。
患者被分为心脏骤停（CA）组或自主循环维持（SC）组。通过尝试次数评估插管困难程度。
由未接受麻醉培训的医生（46%）、住院医师（38%）、麻醉师（8%）或麻醉护士（7%）连续进行了224次紧急气管插管。所有患者最多三次尝试后均成功插管。首次尝试成功率为91%。CA患者（n = 76）为92%，SC患者为90%（P = 0.59）。在SC患者中，84%的插管使用了有（n = 112）或无（n = 12）琥珀酰胆碱的麻醉诱导。30名患者（20%）出现并发症。并发症与医院死亡率、通气支持时间、重症监护病房住院时间之间无相关性。
在本研究中，SC患者的紧急气管插管常通过快速序贯诱导促进，且与CA患者一样首次尝试成功率高。发病率低。所有参与紧急气道管理的医生都应熟练掌握该技术。
