Paramedic rapid sequence intubation for severe traumatic brain injury: Perspectives from an expert panel
Paramedic rapid sequence intubation for severe traumatic brain injury: Perspectives from an expert panel
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DOI：
10.1080/10903120601021093
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发表时间：
2007-01-01
影响因子：
2.4
通讯作者：
Robinson, Linda
中科院分区：
文献类型：
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作者：
Davis, Daniel P.;Fakhry, Samir M.;Robinson, Linda
虽然早期插管已成为重型颅脑损伤(TBI)院前处理的标准做法，但许多患者在没有神经肌肉阻断的情况下无法插管。几个急救医疗服务(EMS)系统已经实施了辅助医疗快速顺序插管(RSI)协议，已发表的报告记录了明显相互矛盾的结果影响。作为回应，脑创伤基金会召集了一个专家小组来解释关于重型颅脑损伤的辅助医疗RSI的现有文献，并为考虑将这一技能添加到辅助医疗实践范围的EMS系统提供指导。这个小组的解释可以总结如下：(1)现有的关于辅助医疗RSI的文献没有定论，结果的明显差异可以通过使用不同的方法和对照组中的变异性来解释；(2)仅使用格拉斯哥昏迷量表评分来识别需要RSI的脑外伤患者是有限的，需要额外的研究来完善我们的筛查标准；(3)次优的RSI技术以及随后的过度换气可能解释了报告的死亡率增加的一些原因；(4)最初的和正在进行的培训以及RSI的经验似乎影响了操作；(5)辅助医疗RSI计划的成功取决于特定的EMS和创伤系统特征。
Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice. The interpretation of this panel can be summarized as follows: (1) the existing literature regarding paramedic RSI is inconclusive, and apparent differences in outcome can be explained by use of different methodologies and variability in comparison groups; (2) the use of Glasgow Coma Scale score alone to identify TBI patients requiring RSI is limited, with additional research needed to refine our screening criteria; (3) suboptimal RSI technique as well as subsequent hyperventilation may account for some of the mortality increase reported with the procedure; (4) initial and ongoing training as well as experience with RSI appear to affect performance; and (5) the success of a paramedic RSI program is dependent on particular EMS and trauma system characteristics.