METHODS: We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension.
RESULTS: In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups.
CONCLUSIONS: Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
方法:我们从2013年1月1日至2019年8月31日,对HEMS医师进行药物促进插管的患者进行了一项基于注册的队列研究。主要结果是30天死亡率,使用多变量逻辑回归控制患者依赖变量进行分析。每位患者的病例量由主治医师在过去12个月中管理的院前麻醉剂的数量确定。解释变量是按低位(0-12)分组的医师病例量,中间(13-36),和高(≥37)病例体积。次要结果是医疗管理的特征,包括低氧血症和低血压的发生率。
结果:在4818例患者中,医生病例量为511、2033和2274名患者,中介-,和大量病例组,分别。较高的医师病例量与较低的30天死亡率相关(每对数病例数比值比0.79[95%置信区间:0.64-0.98])。大量医师提供者的现场时间较短(中位数28[第25-75百分位数:22-38],与中等32[23-42]和最低32[23-43]例容量组相比;P<0.001)和更高的气管插管首过成功率(98%,与93%和90%相比,分别;P<0.001)。两组之间低氧血症和低血压的发生率相似。
结论:院前麻醉后,病死率似乎较低,由具有较高病例量的医师提供者提供。