Trends in Endotracheal Intubation During In-Hospital Cardiac Arrests: 2001-2018.
Trends in Endotracheal Intubation During In-Hospital Cardiac Arrests: 2001-2018.
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院内心脏骤停期间气管插管的趋势：2001- 2018年。
DOI：
10.1097/ccm.0000000000005120
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发表时间：
2022-01-01
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
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作者：
院内心脏骤停（IHCA）期间的气道管理是复苏努力的基本组成部分，但对IHCA期间插管的时间趋势知之甚少。我们的目的是调查随着时间的推移，在响应国家指南更新的变化，在IHCA气道管理。前瞻性收集数据库的观察性队列研究。参与Get With The Guidelines®-复苏登记的医院的多中心研究，从2001年1月1日至2018年12月31日。经历过IHCA并且在停搏前没有侵入性气道的成年患者。主要结局是2001-2018年的停搏内插管率。我们用广义估计方程构建了多变量回归模型，以确定插管的年调整几率。我们还评估了插管相对于无脉发作和其他停搏措施的时机。我们使用中断时间序列分析来评估2010年高级心脏生命支持指南更新与插管率之间的关联。纳入了来自797家医院的166，849名患者。从2001年到2018年，所有心律的停搏期间插管的患者百分比从69%降至55%，不可电击心律的患者百分比从73%降至60%，可电击心律的患者百分比从58%降至36%（所有3组的趋势p<0.001）。从无脉发作到插管的中位时间从2001年的5分钟（IQR 2-8分钟）增加到2018年的6分钟（IQR 4-10分钟）（趋势p<0.001）。在2010年指南更新后，与干预前相比，插管率随时间推移呈阶梯式下降，下降幅度更大（p <0.001）。随着时间的推移，IHCA期间的气管插管率显著下降，在更新的2010年指南中，胸部按压优先于气道管理后，气管插管率下降幅度更大。
Airway management during in-hospital cardiac arrest (IHCA) represents a fundamental component of resuscitative efforts, yet little is known about temporal trends in intubation during IHCA. Our objective was to investigate changes in IHCA airway management over time and in response to national guideline updates. Observational cohort study of a prospectively collected database. Multicenter study of hospitals participating in the Get With The Guidelines®— Resuscitation registry from January 1, 2001 through December 31, 2018. Adult patients who experienced an IHCA and did not have an invasive airway in place prior to the arrest. The primary outcome was the rate of intra-arrest intubation from 2001-2018. We constructed multivariable regression models with generalized estimating equations to determine the annual adjusted odds of intubation. We also assessed the timing of intubation relative to the onset of pulselessness and other arrest measures. We used an interrupted time series analysis to assess the association between the 2010 Advanced Cardiac Life Support guideline update and intubation rates. 166,849 patients from 797 hospitals were included. From 2001 to 2018, the percentage of patients intubated during an arrest decreased from 69% to 55% for all rhythms, 73% to 60% for nonshockable rhythms, and 58% to 36% for shockable rhythms (p<0.001 for trend for all 3 groups). The median time from onset of pulselessness to intubation increased from 5 minutes in 2001 (IQR 2-8 minutes) to 6 minutes in 2018 (IQR 4-10 minutes) (p<0.001 for trend). Following the 2010 guideline update, there was a downward step change and a steeper decrease over time in the rate of intubation as compared to the pre-intervention period (p <0.001). Endotracheal intubation rates during IHCA have decreased significantly over time, with a more substantial decline following the updated 2010 guideline that prioritized chest compressions over airway management.