Paramedic Training for Proficient Prehospital Endotracheal Intubation
Paramedic Training for Proficient Prehospital Endotracheal Intubation
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DOI：
10.3109/10903120903144858
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发表时间：
2010-01-01
影响因子：
2.4
通讯作者：
Sharar, Sam R.
中科院分区：
文献类型：
--
作者：
Warner, Keir J.;Carlbom, David;Sharar, Sam R.
背景紧急气道管理是危重患者复苏的重要组成部分。多项研究证实了院前提供者的可变气管插管（ETI）成功率。描述需要多少ETI培训经验才能获得高成功率的数据很少。目标.描述院前ETI经验的数量与后续ETI成功的可能性之间的关系，并在具有大量资源的大学培训计划中专门研究简单的首过ETI。方法.我们对前瞻性收集的护理人员学生院前插管尝试队列进行了二次分析。收集的关于院前ETI的数据包括适应症、诱导剂、直接喉镜检查尝试次数和进行的高级气道手术。我们使用多变量广义估计方程（GEE）分析来确定累积ETI经验对首次通过和总体ETI成功率的影响。结果在三年的时间里，56名护理学生尝试了576次院前ETI。总体ETI成功的几率与累积ETI经验相关（每次治疗的比值比[OR] 1.097，95%置信区间[CI] = 1.026-1.173，p = 0.006）。首次通过ETI成功的几率与累积ETI经验相关（每次就诊OR 1.061，95% CI = 1.014-1.109，p = 0.009）。结论在具有大量临床机会和资源的培训计划中，ETI成功率的增加与临床暴露的增加相关。然而，具有高成功率的ETT的第一次通过安置需要大量的ETI培训经验，这可能超过许多培训计划中可用的数量。
Background. Emergency airway management is an important component of resuscitation of critically ill patients. Multiple studies demonstrate variable endotracheal intubation (ETI) success by prehospital providers. Data describing how many ETI training experiences are required to achieve high success rates are sparse. Objectives. To describe the relationship between the number of prehospital ETI experiences and the likelihood of success on subsequent ETI and to specifically look at uncomplicated first-pass ETI in a university-based training program with substantial resources. Methods. We conducted a secondary analysis of a prospectively collected cohort of paramedic student prehospital intubation attempts. Data collected on prehospital ETIs included indication, induction agents, number of direct laryngoscopy attempts, and advanced airway procedures performed. We used multivariable generalized estimating equations (GEE) analysis to determine the effect of cumulative ETI experience on first-pass and overall ETI success rates. Results. Over a period of three years, 56 paramedic students attempted 576 prehospital ETIs. The odds of overall ETI success were associated with cumulative ETI experience (odds ratio [OR] 1.097 per encounter, 95% confidence interval [CI] = 1.026-1.173, p = 0.006). The odds of first-pass ETI success were associated with cumulative ETI experience (OR 1.061 per encounter, 95% CI = 1.014-1.109, p = 0.009). Conclusion. In a training program with substantial clinical opportunities and resources, increased ETI success rates were associated with increasing clinical exposure. However, first-pass placement of the ETT with a high success rate requires high numbers of ETI training experiences that may exceed the number available in many training programs.