Assessing the Impact of Prehospital Intubation on Survival in Out-of-Hospital Cardiac Arrest
Assessing the Impact of Prehospital Intubation on Survival in Out-of-Hospital Cardiac Arrest
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DOI：
10.3109/10903127.2010.514090
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发表时间：
2011-01-01
影响因子：
2.4
通讯作者：
Swor, Robert A.
中科院分区：
文献类型：
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作者：
Egly, Joshua;Custodio, Don;Swor, Robert A.
有发展中的文献记载院外气管插管治疗危重多发伤和颅脑损伤患者的不良生存结果。目标。比较院外成功插管和未插管的非创伤性院外心脏骤停患者的住院和出院存活率。方法：研究方法。我们对1995至2006年间由辅助医疗服务机构送至大型郊区三级护理急诊科的一个持续数据库进行了回溯性分析。我们根据患者是否在到达医院之前成功地经气管插管将患者分为两类。所有病例均提取了Utstein式心脏骤停变量。对所有住院的幸存者进行回顾，排除那些没有尝试插管或没有必要插管的患者，例如那些首次休克成功恢复自主循环的患者。我们使用卡方和Logistic回归技术进行分析，将存活到出院作为主要结果，将存活到入院作为次要结果。结果。总共有1,515例，排除了33名早期幸存者。总体而言，1220人(86.2%)接受了插管；在插管者中，270人(20.2%)存活到入院，93人(7.0%)存活到出院。单因素分析显示，插管组与未插管组的生存率差异无统计学意义(6.5%vs10.0%，OR=0.63，95%CI 0.37，1.08)。对于初发室颤/室性心动过速(VT/VF)的患者，在多变量Logit模型中，插管显著降低了患者的存活率和出院时间，调整后的优势比(OR)=0.52(95%可信区间0.27，0.998)。插管的非室性心动过速患者更有可能存活到入院，调整后的OR为2.96(1.04，8.43)，但不能出院(1.8%比1.0%，p=1.0)。结论。这项在非选定人群中的观察性研究表明，在院外插管的室颤/室速骤停患者比那些没有插管的患者存活到出院的可能性更小。非室性心动过速骤停患者院外插管与入院存活率增加有关，但与存活率到出院存活率无关。未来需要进行前瞻性研究，以明确院外气管插管在心脏骤停患者中的作用。
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. Objective. To compare the rates of survival to hospital admission and discharge of nontraumatic out-of-hospital cardiac arrest (OHCA) patients who received successful out-of-hospital endotracheal intubation and those who were not intubated. Methods. We conducted a retrospective analysis from an ongoing database of OHCA patients brought to a large suburban tertiary care emergency department by paramedic services between 1995 and 2006. We dichotomized patients by whether they were successfully endotracheally intubated or not prior to hospital arrival. Utstein style cardiac arrest variables were abstracted for all cases. All survivors to hospital admission were reviewed to exclude those patients in whom intubation was not attempted or unnecessary, such as those who had successful first-shock recovery of spontaneous circulation. We used chi square and logistic regression techniques for analysis, using survival to discharge as the primary outcome and survival to admission as a secondary outcome. Results. There were 1,515 total cases with 33 early survivors excluded. Overall, 1,220 (86.2%) were intubated; of those intubated, 270 (20.2%) survived to admission and 93 (7.0%) survived to discharge. Upon univariate analysis, there was no difference in survival between intubated and non intubated groups (6.5% vs 10.0%, OR = 0.63, 95% CI 0.37,1.08). For patients initially in ventricular fibrillation/ventricular tachycardia (VT/VF), in a multivariate Logit model, intubation significantly decreased survival to discharge, adjusted odds ratio (OR) = 0.52 (95% confidence interval 0.27, 0.998). Intubated non-VF patients were more likely to survive to admission, adjusted OR 2.96 (1.04, 8.43), but not to discharge (1.8% vs. 1.0%, p = 1.0). Conclusion. This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.