■院前伤害护理(EPIC)的卓越研究表明,在实施院前治疗指南后,严重创伤性脑损伤(TBI)患者的生存率提高。在接受正压通气(PPV)的患者亚组中实施这些指南的影响尚不清楚。
■评估院前TBI循证指南的实施与院前PPV患者生存的相关性。
■EPIC研究是一个多系统,使用前/后对照设计的意向治疗研究。亚利桑那州的紧急医疗服务机构实施了循证指南。此子分析是先验计划的,包括接受院前PPV的参与者。使用逻辑回归比较实施前和实施后队列之间的结果,按预定的TBI严重程度类别分层(中度,严重,或关键)。数据收集时间为2007年1月至2017年6月,数据分析时间为2023年1月至2月。
■实施基于证据的TBI患者院前护理指南。
■主要结果是生存到出院,次要结局是生存至入院.
■在主要研究的21852名参与者中,5022接受院前PPV(实施前,3531名参与者;实施后,1491名参与者)。包括5022名参与者,男性3720人(74.1%),中位年龄(IQR)为36(22-54)岁。在所有严重性组合中,生存率提高(调整后的优势比[AOR],1.59;95%CI,1.28-1.97),而存活到出院没有(AOR,0.94;95%CI,0.78-1.13)。在患有严重TBI的队列中,但不在中度或危重亚组中,住院生存率增加(AOR,6.44;95%CI,2.39-22.00),从存活到出院(AOR,3.52;95%CI,1.96-6.34)。
■在现场接受主动气道干预的重度TBI患者中,指南的实施与住院和出院前生存率的提高独立相关.无论他们接受基本气道干预还是高级气道干预,都是如此。这些发现支持当前指南建议积极预防/纠正重度TBI患者的缺氧和过度通气。无论使用哪种类型的气道。
UNASSIGNED: The Excellence in Prehospital Injury Care (EPIC) study demonstrated improved survival in patients with severe traumatic brain injury (TBI) following implementation of the prehospital treatment
guidelines. The impact of implementing these
guidelines in the subgroup of patients who received positive pressure ventilation (PPV) is unknown.
UNASSIGNED: To evaluate the association of implementation of prehospital TBI evidence-based guidelines with survival among patients with prehospital PPV.
UNASSIGNED: The EPIC study was a multisystem, intention-to-treat study using a before/after controlled design. Evidence-based
guidelines were implemented by emergency medical service agencies across Arizona. This subanalysis was planned a priori and included participants who received prehospital PPV. Outcomes were compared between the preimplementation and postimplementation cohorts using logistic regression, stratified by predetermined TBI severity categories (moderate, severe, or critical). Data were collected from January 2007 to June 2017, and data were analyzed from January to February 2023.
UNASSIGNED: Implementation of the evidence-based guidelines for the prehospital care of patient with TBI.
UNASSIGNED: The primary outcome was survival to hospital discharge, and the secondary outcome was survival to admission.
UNASSIGNED: Among the 21 852 participants in the main study, 5022 received prehospital PPV (preimplementation, 3531 participants; postimplementation, 1491 participants). Of 5022 included participants, 3720 (74.1%) were male, and the median (IQR) age was 36 (22-54) years. Across all severities combined, survival to admission improved (adjusted odds ratio [aOR], 1.59; 95% CI, 1.28-1.97), while survival to discharge did not (aOR, 0.94; 95% CI, 0.78-1.13). Within the cohort with severe TBI but not in the moderate or critical subgroups, survival to hospital admission increased (aOR, 6.44; 95% CI, 2.39-22.00), as did survival to discharge (aOR, 3.52; 95% CI, 1.96-6.34).
UNASSIGNED: Among patients with severe TBI who received active airway interventions in the field,
guideline implementation was independently associated with improved survival to hospital admission and discharge. This was true whether they received basic airway interventions or advanced airways. These findings support the current
guideline recommendations for aggressive prevention/correction of hypoxia and hyperventilation in patients with severe TBI, regardless of which airway type is used.