{Reference Type}: Journal Article
{Title}: Association between case volume and mortality in pre-hospital anaesthesia management: a retrospective observational cohort.
{Author}: Saviluoto A;Jäntti H;Kirves H;Setälä P;Nurmi JO;
{Journal}: Br J Anaesth
{Volume}: 128
{Issue}: 2
{Year}: Feb 2022
{Factor}: 11.719
{DOI}: 10.1016/j.bja.2021.08.029
{Abstract}: <B>BACKGROUND: </B>Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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.<BR><B>CONCLUSIONS: </B>Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.