背景:气管插管在心肺复苏过程中具有挑战性,视频喉镜检查显示了该程序的好处。这项研究的目的是比较各种插管方法的有效性,包括首先的Bougie,预装的Bougie,气管内导管(ETT)与管心针,和ETT没有探针,在胸部按压期间使用视频喉镜首次尝试成功。
方法:这是一项在普通三级教学医院进行的随机交叉试验。我们包括通过筛查测试的研究生一至三年级的麻醉住院医师。在连续的胸部按压过程中,每位居民使用四种随机顺序的方法对成年人体模型进行视频喉镜插管。主要结果是首次尝试成功,定义为在一分钟内开始通气。
结果:对65名居民进行的260次气管内插管进行随机分组,每组65次。第一次尝试成功发生在64(98.5%),57(87.7%),56(86.2%),46例(70.8%)插管,预装的Bougie,ETT带通心针,和ETT没有探针方法,分别。bougie-first方法的首次尝试成功的可能性明显高于预装bougie方法[风险比(RR)8.00,95%置信区间(CI)1.03至62.16,P=0.047],采用探针法的ETT(RR9.00,95%CI1.17至69.02,P=0.035),在广义估计方程逻辑模型中,无探针方法的ETT(RR19.00,95%CI2.62至137.79,P=0.004)考虑了同一居民操作的插管的聚类。此外,在研究参与者中,bougiefirst方法没有导致插管时间延长或自我报告的难度增加.
结论:在胸部按压过程中,视频喉镜检查的首次尝试成功的可能性最高。这些结果有助于在CPR期间告知插管方法。然而,需要在实际临床环境中进行进一步的研究来验证这些发现.
背景:Clinicaltrials.gov;标识符:NCT05689125;日期:2023年1月18日。
BACKGROUND: Endotracheal intubation is challenging during cardiopulmonary resuscitation, and video laryngoscopy has showed benefits for this procedure. The aim of this study was to compare the effectiveness of various intubation approaches, including the bougie first, preloaded bougie, endotracheal tube (ETT) with stylet, and ETT without stylet, on first-attempt success using video laryngoscopy during chest compression.
METHODS: This was a randomized crossover trial conducted in a general tertiary teaching hospital. We included anesthesia residents in postgraduate year one to three who passed the screening test. Each resident performed intubation with video laryngoscopy using the four approaches in a randomized sequence on an adult manikin during continuous chest compression. The primary outcome was the first-attempt success defined as starting ventilation within a one minute.
RESULTS: A total of 260 endotracheal intubations conducted by 65 residents were randomized and analyzed with 65 procedures in each group. First-attempt success occurred in 64 (98.5%), 57 (87.7%), 56 (86.2%), and 46 (70.8%) intubations in the bougie-first, preloaded bougie, ETT with stylet, and ETT without stylet approaches, respectively. The bougie-first approach had a significantly higher possibility of first-attempt success than the preloaded bougie approach [risk ratio (RR) 8.00, 95% confidence interval (CI) 1.03 to 62.16, P = 0.047], the ETT with stylet approach (RR 9.00, 95% CI 1.17 to 69.02, P = 0.035), and the ETT without stylet approach (RR 19.00, 95% CI 2.62 to 137.79, P = 0.004) in the generalized estimating equation logistic model accounting for clustering of intubations operated by the same resident. In addition, the bougie first approach did not result in prolonged intubation or increased self-reported difficulty among the study participants.
CONCLUSIONS: The bougie first approach with video laryngoscopy had the highest possibility of first-attempt success during chest compression. These results helped inform the intubation approach during CPR. However, further studies in an actual clinical environment are warranted to validate these findings.
BACKGROUND: Clinicaltrials.gov; identifier: NCT05689125; date: January 18, 2023.