Out-of-hospital airway management in the United States
Out-of-hospital airway management in the United States
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DOI：
10.1016/j.resuscitation.2010.12.014
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发表时间：
2011-04-01
期刊：
影响因子：
6.5
通讯作者：
Yealy, Donald M.
中科院分区：
文献类型：
--
作者：
Wang, Henry E.;Mann, N. Clay;Yealy, Donald M.
目的：先前的研究描述了单一EMS机构、地区或州的气道管理。我们试图描述美国的院外气道管理干预、结果和并发症。方法：使用2008年国家紧急医疗服务信息系统（NEMSIS）公开发布的数据集（包含来自16个州的数据），我们确定了接受高级气道管理的患者，包括气管内插管（ETI）、替代气道（AIT）和呼吸道（AIT）。（Combitube、喉罩气道（LMA）、King LT、食管阻塞气道（EOA））和环甲膜切开术（针式和开放式）。我们检查了整个队列和关键子集（心脏骤停、非骤停医疗、非骤停损伤、< 10岁和10-19岁儿童、快速序列插管（RSI）、人群设置和美国人口普查地区）的气道管理成功率和并发症。结果：在4，383，768例EM激活中，有10，356例ETI，2246例备用气道和88例环甲膜切开术。ETI成功率为：总体6482/8418（77.0%; 95% CI：76.1-77.9%），心脏骤停3494/4482（78.0%），非逮捕医疗616/846（72.8%），非制动伤417/505（82.6%），10岁以下儿童295/397（74.3%），10-19岁儿童228/289（78.9%），成人5829/7552（77.2%），快速序列插管289/355（81.4%）。ETI的成功率在美国南部人口普查地区最低。替代气道成功率为1564/1794（87.2%）。主要并发症包括：出血84例（7.0/1000干预），呕吐80例（6.7/1000）和食管插管12例（1.0/1000）。结论：在这项描述美国医院外气道管理特征的研究中，我们观察到医院外ETI成功率较低。这些数据可以指导国家努力提高医院外气道管理的质量。(C)2011爱思唯尔爱尔兰有限公司保留所有权利。
Objective: Prior studies describe airway management by single EMS agencies, regions or states. We sought to characterize out-of-hospital airway management interventions, outcomes and complications across the United States.Methods: Using the 2008 National Emergency Medical Services Information System (NEMSIS) Public-Release Data Set containing data from 16 states, we identified patients receiving advanced airway management, including endotracheal intubation (ETI), alternate airways (Combitube, Laryngeal Mask Airway (LMA), King LT, Esophageal-Obturator Airway (EOA)), and cricothyroidotomy (needle and open). We examined airway management success and complications in the full cohort and in key subsets (cardiac arrest, non-arrest medical, non-arrest injury, children < 10 and 10-19 years, rapid-sequence intubation (RSI), population setting and US census region). We analyzed the data using descriptive statistics.Results: Among 4, 383, 768 EMSactivations, there were 10,356 ETI, 2246 alternate airways, and 88 cricothyroidotomies. ETI success rates were: overall 6482/8418 (77.0%; 95% CI: 76.1-77.9%), cardiac arrest 3494/4482 (78.0%), non-arrest medical 616/846 (72.8%), non-arrest injury 417/505 (82.6%), children < 10 years 295/397 (74.3%), children 10-19 years 228/289 (78.9%), adult 5829/7552 (77.2%), and rapid-sequence intubation 289/355 (81.4%). ETI success was success was lowest in the South US census region. Alternate airway success was 1564/1794 (87.2%). Major complications included: bleeding 84 (7.0 per 1000 interventions), vomiting 80 (6.7 per 1000) and esophageal intubation 12 (1.0 per 1000).Conclusions: In this study characterizing out-of-hospital airway management across the United States, we observed low out-of-hospital ETI success rates. These data may guide national efforts to improve the quality of out-of-hospital airway management. (C) 2011 Elsevier Ireland Ltd. All rights reserved.