Slater E A, Weiss S J, Ernst A A, Haynes M
Vanderbilt University Lifeflight, Vanderbilt University, Nashville, Tennessee, USA.
J Trauma. 1998 Sep;45(3):588-92. doi: 10.1097/00005373-199809000-00031.
Maintenance of an airway in the air medically transported patient is of paramount importance. The purpose of this study is to compare preflight versus en route rapid sequence intubation (RSI)-assisted intubations and to determine the value of air medical use of RSI.
This study is a 31-month retrospective review of all patients intubated and transported by a large city air medical service. Subgroup analysis was based on whether patients were transported from a hospital or a scene and whether they were intubated preflight or en route. Information on age, Glasgow Coma Scale score, type of scene, ground time, and previous attempts at intubation was recorded. Complications included failures, multiple attempts at intubation, arrhythmias, and need for repeated paralytic agents. Comparisons were made using a confidence interval analysis. An alpha of 0.05 was considered significant; Bonferroni correction was used for multiple comparisons.
Three hundred twenty-five patients were intubated and transported by Lifeflight during the study period. Two hundred eighty-eight patients were intubated using RSI (89%). The success rate was 97%. Preflight intubations were performed on 100 hospital calls and 86 scene calls. En route intubations were performed on 40 hospital cases and 62 scene calls. Patients who underwent preflight intubations were significantly younger than those who underwent en route intubations for both the hospital group (34 +/- 11 vs. 44 +/- 24 years, p < 0.05) and the scene group (27 +/- 13 vs. 32 +/- 16 years,p < 0.05). Otherwise, the demographic characteristics of the four groups were similar. Trauma accounted for 60 to 70% of hospital transfers and almost 95 to 100% of scene calls. Compared with preflight intubations, there was a significant decrease in ground time for hospital patients who were intubated en route (26 +/- 10 vs. 34 +/- 11 minutes, p < 0.05) and for scene patients who were intubated en route (11 +/- 8 vs. 18 +/- 9 minutes, p < 0.05). There were no significant differences between the groups for number of failures (9 of 288), arrhythmias (18 of 288), or necessity for repeated paralysis (8 of 288). Multiple intubation attempts were performed in more scene preflight patients (30 of 86, 35%) than scene en route patients (16 of 62, 26%), but this did not reach statistical significance. Even for patients having previous attempts at intubation, the success rate using RSI was 93% (62 of 67).
Air medical intubations, both preflight and en route, for both scene calls and interhospital transports, can be done with a very high success rate. Rapid sequence intubation may improve the success rate. For scene calls, there was a significant decrease in ground time, and there was a trend toward fewer multiple intubation attempts when the patient was intubated en route instead of preflight.
对于空中医疗转运的患者，维持气道通畅至关重要。本研究的目的是比较飞行前与途中快速顺序诱导插管（RSI）辅助插管，并确定空中医疗使用RSI的价值。
本研究是对某大城市空中医疗服务机构插管并转运的所有患者进行的为期31个月的回顾性研究。亚组分析基于患者是从医院还是现场转运，以及是在飞行前还是途中插管。记录患者的年龄、格拉斯哥昏迷量表评分、现场类型、地面转运时间以及之前的插管尝试情况。并发症包括插管失败、多次插管尝试、心律失常以及需要重复使用麻痹剂。采用置信区间分析进行比较。α值设定为0.05，差异具有统计学意义；采用Bonferroni校正进行多重比较。
在研究期间，Lifeflight共对325例患者进行了插管和转运。288例患者采用RSI插管（89%）。成功率为97%。飞行前插管用于100例医院转运呼叫和86例现场呼叫。途中插管用于40例医院病例和62例现场呼叫。对于医院组（34±11岁对44±24岁，p<0.05）和现场组（27±13岁对32±16岁，p<0.05），飞行前插管的患者比途中插管的患者明显年轻。除此之外，四组的人口统计学特征相似。创伤占医院转运的60%至70%，几乎占现场呼叫的95%至100%。与飞行前插管相比，途中插管的医院患者（26±10分钟对34±11分钟，p<0.05）和途中插管的现场患者（11±8分钟对18±9分钟，p<0.05）的地面转运时间显著缩短。各组在插管失败数（288例中的9例）、心律失常数（288例中的18例）或重复使用麻痹剂的必要性（288例中的8例）方面无显著差异。现场飞行前患者（86例中的30例，35%）比现场途中患者（62例中的16例，26%）进行多次插管尝试的情况更多，但未达到统计学意义。即使是之前有过插管尝试的患者，使用RSI的成功率也为93%（67例中的62例）。
无论是飞行前还是途中，对于现场呼叫和医院间转运的空中医疗插管，成功率都非常高。快速顺序诱导插管可能会提高成功率。对于现场呼叫，地面转运时间显著缩短，并且当患者在途中而非飞行前插管时，多次插管尝试有减少的趋势。
