Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial.
Bougie-assisted endotracheal intubation in the pragmatic airway resuscitation trial.
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在务实的气道复苏试验中，布吉辅助气管插管。
DOI：
10.1016/j.resuscitation.2020.11.003
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发表时间：
2021-01
期刊：
影响因子：
6.5
通讯作者：
Wang HE
中科院分区：
文献类型：
--
作者：
Bonnette AJ;Aufderheide TP;Jarvis JL;Lesnick JA;Nichol G;Carlson JN;Hansen M;Stephens SW;Colella MR;Wang HE
护理人员可能在治疗院外心脏骤停（OHCA）患者时进行气管插管（ETI）。牙龈弹性探条（探条）是一种插管辅助工具，可优化插管成功率。在OHCA中很少有探条辅助插管的报告，也没有其与结局的相关性。我们在院外实用气道复苏试验（PART）中比较了探条辅助和非探条ETI的插管成功率和OHCA结局。这是对参加实用气道复苏试验（PART）的接受ETI的患者进行的二次分析，该试验是一项多中心临床试验，比较了成人OHCA中插管优先与喉管优先的气道管理策略。主要暴露是使用探条进行ET辅助。主要终点为首次通过ETI成功。次要终点包括总体ETI成功率、至成功ETI的时间、自主循环恢复、72小时生存率、住院生存率和神经系统状态良好的住院生存率（改良兰金评分≤3）。我们使用广义估计方程和考克斯回归分析数据，调整已知的混杂因素。在入组PART的3，004例患者中，1，227例接受了ETI，包括440例（35.9%）探条辅助ETI和787例（64.1%）非探条ETI。探条辅助和非探条ETI的首次通过ETI成功率无差异（53.1% vs. 42.8%;调整后OR 1.12，95% CI：0.97 - 1.39）。探条辅助组的ETI总体成功率略高（56.2% vs. 49.1%;调整后OR 1.19，95% CI：1.01 - 1.32）。探条辅助ETI的气管插管置入或放弃时间长于非探条ETI（中位数13 vs. 11 min;调整HR 0. 63，95% CI：0. 45 - 0. 90）。虽然探条辅助ETI的出院生存率低于非探条ETI（3.6% vs. 7.5%;调整OR 0.94，95% CI：0.92 - 0.96），但ROSC、72小时生存率或住院生存率或神经系统状态良好的住院生存率无差异。虽然显示出略高的ETI总体成功率，探条辅助ETI需要更长的气道放置时间和潜在的生存率较低。在人道主义事务协调厅的东帝汶过渡当局中，探员援助的作用仍然不清楚。
Paramedics may perform endotracheal intubation (ETI) while treating patients with out-of-hospital cardiac arrest (OHCA). The gum elastic Bougie (Bougie) is an intubation adjunct that may optimize intubation success. There are few reports of Bougie-assisted intubation in OHCA nor its association with outcomes. We compared intubation success rates and OHCA outcomes between Bougie-assisted and non-Bougie ETI in the out-of-hospital Pragmatic Airway Resuscitation Trial (PART). This was a secondary analysis of patients receiving ETI enrolled in the Pragmatic Airway Resuscitation Trial (PART), a multicenter clinical trial comparing intubation-first vs. laryngeal tube-first strategies of airway management in adult OHCA. The primary exposure was use of Bougie for ETI-assistance. The primary endpoint was first-pass ETI success. Secondary endpoints included overall ETI success, time to successful ETI, return of spontaneous circulation, 72-hour survival, hospital survival and hospital survival with favorable neurologic status (modified Rankin Score ≤3). We analyzed the data using Generalized Estimating Equations and Cox Regression, adjusting for known confounders. Of the 3,004 patients enrolled in PART, 1,227 received ETI, including 440 (35.9%) Bougie-assisted and 787 (64.1%) non-Bougie ETIs. First-pass ETI success did not differ between Bougie-assisted and non-Bougie ETI (53.1% vs. 42.8%; adjusted OR 1.12, 95% CI: 0.97 to 1.39). ETI overall success was slightly higher in the Bougie-assisted group (56.2% vs. 49.1%; adjusted OR 1.19, 95% CI: 1.01 to 1.32). Time to endotracheal tube placement or abandonment was longer for Bougie-assisted than non-Bougie ETI (median 13 vs. 11 min; adjusted HR 0.63, 95% CI: 0.45 to 0.90). While survival to hospital discharge was lower for Bougie-assisted than non-Bougie ETI (3.6% vs. 7.5%; adjusted OR 0.94, 95% CI: 0.92 to 0.96), there were no differences in ROSC, 72-hour survival or hospital survival or hospital survival with favorable neurologic status. While exhibiting slightly higher ETI overall success rates, Bougie-assisted ETI entailed longer airway placement times and potentially lower survival. The role of the Bougie assistance in ETI of OHCA remains unclear.
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