PDF(Pubmed)
Abstract：
BACKGROUND: Accurate haemodynamic monitoring in the prehospital setting is essential. Non-invasive blood pressure measurement is susceptible to vibration and motion artefact, especially at extremes of hypotension and hypertension: invasive arterial blood pressure (IABP) monitoring is a potential solution. This study describes the largest series to date of cases of IABP monitoring being initiated prehospital.
METHODS: This retrospective observational study was conducted at East Anglian Air Ambulance (EAAA), a UK helicopter emergency medical service (HEMS). It included all patients attended by EAAA who underwent arterial catheterisation and initiation of IABP monitoring between 1st February 2015 and 20th April 2023. The following data were retrieved for all patients: sex; age; aetiology (medical cardiac arrest, other medical emergency, trauma); site of arterial cannulation; operator role (doctor/paramedic); time of insertion and, where applicable, times of pre-hospital emergency anaesthesia, and return of spontaneous circulation following cardiac arrest. Descriptive analyses were performed to characterise the sample.
RESULTS: 13,556 patients were attended: IABP monitoring was initiated in 1083 (8.0%) cases, with a median age 59 years, of which 70.8% were male. 546 cases were of medical cardiac arrest: in 22.4% of these IABP monitoring was initiated during cardiopulmonary resuscitation. 322 were trauma cases, and the remaining 215 were medical emergencies. The patients were critically unwell: 981 required intubation, of which 789 underwent prehospital emergency anaesthesia; 609 received vasoactive medication. In 424 cases IABP monitoring was instituted en route to hospital.
CONCLUSIONS: This study describes over 1000 cases of prehospital arterial catheterisation and IABP monitoring in a UK HEMS system and has demonstrated feasibility at scale. The high-fidelity of invasive arterial blood pressure monitoring with the additional benefit of arterial blood gas analysis presents an attractive translation of in-hospital critical care to the prehospital setting.
METHODS: This retrospective observational study was conducted at East Anglian Air Ambulance (EAAA), a UK helicopter emergency medical service (HEMS). It included all patients attended by EAAA who underwent arterial catheterisation and initiation of IABP monitoring between 1st February 2015 and 20th April 2023. The following data were retrieved for all patients: sex; age; aetiology (medical cardiac arrest, other medical emergency, trauma); site of arterial cannulation; operator role (doctor/paramedic); time of insertion and, where applicable, times of pre-hospital emergency anaesthesia, and return of spontaneous circulation following cardiac arrest. Descriptive analyses were performed to characterise the sample.
RESULTS: 13,556 patients were attended: IABP monitoring was initiated in 1083 (8.0%) cases, with a median age 59 years, of which 70.8% were male. 546 cases were of medical cardiac arrest: in 22.4% of these IABP monitoring was initiated during cardiopulmonary resuscitation. 322 were trauma cases, and the remaining 215 were medical emergencies. The patients were critically unwell: 981 required intubation, of which 789 underwent prehospital emergency anaesthesia; 609 received vasoactive medication. In 424 cases IABP monitoring was instituted en route to hospital.
CONCLUSIONS: This study describes over 1000 cases of prehospital arterial catheterisation and IABP monitoring in a UK HEMS system and has demonstrated feasibility at scale. The high-fidelity of invasive arterial blood pressure monitoring with the additional benefit of arterial blood gas analysis presents an attractive translation of in-hospital critical care to the prehospital setting.
摘要：
背景：院前环境中准确的血流动力学监测至关重要。无创血压测量易受振动和运动伪影的影响，特别是在低血压和高血压的极端情况下：有创动脉血压（IABP）监测是一种潜在的解决方案。这项研究描述了迄今为止最大的一系列医院前开始进行IABP监测的病例。
方法：这项回顾性观察研究是在东英吉利航空救护车（EAAA）进行的，英国直升机紧急医疗服务（HEMS）。它包括2015年2月1日至2023年4月20日期间接受动脉导管插入和开始IABP监测的所有接受EAAA治疗的患者。检索到所有患者的以下数据：性别；年龄；病因（医疗心脏骤停，其他医疗紧急情况,创伤）；动脉插管部位；操作员角色（医生/护理人员）；插入时间，如果适用，院前急救麻醉的次数，和心脏骤停后自发循环的恢复。进行描述性分析以表征样品。
结果：13,556例患者就诊：1083例（8.0％）患者开始进行IABP监测，平均年龄59岁，其中70.8%为男性。546例患者为医疗心脏骤停：在心肺复苏期间启动了这些IABP监测的22.4％。322例创伤病例，剩下的215个是医疗紧急情况。患者严重不适：981需要插管，其中789人接受了院前急诊麻醉;609人接受了血管活性药物治疗。在424例病例中，在去医院的途中建立了IABP监测。
结论：这项研究描述了英国HEMS系统中1000多例院前动脉导管插入术和IABP监测，并已大规模证明了可行性。有创动脉血压监测的高保真性以及动脉血气分析的额外优势为医院重症监护提供了有吸引力的转化。
方法：这项回顾性观察研究是在东英吉利航空救护车（EAAA）进行的，英国直升机紧急医疗服务（HEMS）。它包括2015年2月1日至2023年4月20日期间接受动脉导管插入和开始IABP监测的所有接受EAAA治疗的患者。检索到所有患者的以下数据：性别；年龄；病因（医疗心脏骤停，其他医疗紧急情况,创伤）；动脉插管部位；操作员角色（医生/护理人员）；插入时间，如果适用，院前急救麻醉的次数，和心脏骤停后自发循环的恢复。进行描述性分析以表征样品。
结果：13,556例患者就诊：1083例（8.0％）患者开始进行IABP监测，平均年龄59岁，其中70.8%为男性。546例患者为医疗心脏骤停：在心肺复苏期间启动了这些IABP监测的22.4％。322例创伤病例，剩下的215个是医疗紧急情况。患者严重不适：981需要插管，其中789人接受了院前急诊麻醉;609人接受了血管活性药物治疗。在424例病例中，在去医院的途中建立了IABP监测。
结论：这项研究描述了英国HEMS系统中1000多例院前动脉导管插入术和IABP监测，并已大规模证明了可行性。有创动脉血压监测的高保真性以及动脉血气分析的额外优势为医院重症监护提供了有吸引力的转化。
