Abstract：
BACKGROUND: Prehospital anaesthesia is a complex intervention performed for critically ill patients. To minimise complications, a standard operating procedure (SOP) outlining the process is considered valuable. We investigated the implementation of an SOP for prehospital anaesthesia in helicopter emergency medical services (HEMS).
METHODS: We performed a retrospective observational study of patients receiving prehospital anaesthesia by Finnish HEMS from January 2012 to August 2019. The intervention studied was the implementation of an SOP at two of the five bases during 2015-2016. Patients were stratified according to whether they were anaesthetised before, during or after implementation and the primary outcomes were 1- and 30-day mortality. Secondary outcomes included anaesthesia quality indicators. Confounding factors was assessed via logistic regression.
RESULTS: A total of 3902 tracheal intubations were performed without an SOP, 430 during implementation and 1525 after implementation. The SOP had a significant effect on 1-day mortality during implementation with an odds ratio (OR) of 0.56, 95% confidence interval (95% CI) 0.37-0.81 and a further trend towards benefit after implementation (OR 0.84, 95% CI 0.68-1.04), but no difference in 30-day mortality (OR after implementation 1.10, 95% CI 0.92-1.30). Implementation of an SOP improved first-pass success rate from 87.3% to 96.5%, p < 0.001.
CONCLUSIONS: Implementation of an SOP for prehospital anaesthesia was associated with a trend towards lower 1-day mortality and an improved first-pass success but did not affect 30-day mortality. Despite this, we advocate prehospital systems to consider implementation of a prehospital anaesthesia SOP as immediate performance markers improved significantly.
METHODS: We performed a retrospective observational study of patients receiving prehospital anaesthesia by Finnish HEMS from January 2012 to August 2019. The intervention studied was the implementation of an SOP at two of the five bases during 2015-2016. Patients were stratified according to whether they were anaesthetised before, during or after implementation and the primary outcomes were 1- and 30-day mortality. Secondary outcomes included anaesthesia quality indicators. Confounding factors was assessed via logistic regression.
RESULTS: A total of 3902 tracheal intubations were performed without an SOP, 430 during implementation and 1525 after implementation. The SOP had a significant effect on 1-day mortality during implementation with an odds ratio (OR) of 0.56, 95% confidence interval (95% CI) 0.37-0.81 and a further trend towards benefit after implementation (OR 0.84, 95% CI 0.68-1.04), but no difference in 30-day mortality (OR after implementation 1.10, 95% CI 0.92-1.30). Implementation of an SOP improved first-pass success rate from 87.3% to 96.5%, p < 0.001.
CONCLUSIONS: Implementation of an SOP for prehospital anaesthesia was associated with a trend towards lower 1-day mortality and an improved first-pass success but did not affect 30-day mortality. Despite this, we advocate prehospital systems to consider implementation of a prehospital anaesthesia SOP as immediate performance markers improved significantly.
摘要：
背景：院前麻醉是对危重患者实施的复杂干预措施。为了尽量减少并发症，概述该过程的标准操作程序(SOP)被认为是有价值的。我们调查了直升机紧急医疗服务（HEMS）中院前麻醉SOP的实施情况。
方法：我们于2012年1月至2019年8月对接受芬兰HEMS院前麻醉的患者进行了一项回顾性观察性研究。研究的干预措施是在2015-2016年期间在五个基地中的两个基地实施SOP。根据患者之前是否麻醉进行分层，实施过程中或实施后,主要结局为1日和30日死亡率.次要结果包括麻醉质量指标。混杂因素通过logistic回归进行评估。
结果：共进行了3902次气管插管，没有进行SOP，在实施期间为430，在实施之后为1525。SOP在实施过程中对1天死亡率有显著影响，比值比(OR)为0.56，95%置信区间(95%CI)为0.37-0.81，实施后有进一步的获益趋势(OR0.84，95%CI0.68-1.04)，但30天死亡率无差异(实施后OR1.10，95%CI0.92-1.30)。SOP的实施将首过成功率从87.3%提高到96.5%，p<0.001。
结论：实施院前麻醉SOP与降低1天死亡率和提高首过成功率的趋势相关，但不影响30天死亡率。尽管如此,我们提倡院前系统考虑实施院前麻醉SOP,因为即时性能指标显著改善.
方法：我们于2012年1月至2019年8月对接受芬兰HEMS院前麻醉的患者进行了一项回顾性观察性研究。研究的干预措施是在2015-2016年期间在五个基地中的两个基地实施SOP。根据患者之前是否麻醉进行分层，实施过程中或实施后,主要结局为1日和30日死亡率.次要结果包括麻醉质量指标。混杂因素通过logistic回归进行评估。
结果：共进行了3902次气管插管，没有进行SOP，在实施期间为430，在实施之后为1525。SOP在实施过程中对1天死亡率有显著影响，比值比(OR)为0.56，95%置信区间(95%CI)为0.37-0.81，实施后有进一步的获益趋势(OR0.84，95%CI0.68-1.04)，但30天死亡率无差异(实施后OR1.10，95%CI0.92-1.30)。SOP的实施将首过成功率从87.3%提高到96.5%，p<0.001。
结论：实施院前麻醉SOP与降低1天死亡率和提高首过成功率的趋势相关，但不影响30天死亡率。尽管如此,我们提倡院前系统考虑实施院前麻醉SOP,因为即时性能指标显著改善.
