背景:院前气道管理对于全球紧急医疗服务(EMS)系统的质量和安全性仍然至关重要。2007年,Timmermann等人的基准研究。通过揭示大量未检测到的食管插管导致通常致命的结果,对德国EMS社区造成了沉重打击。从那以后,指南的制定和培训受到了极大的关注。这项研究从直升机紧急医疗服务的角度评估了导管错位作为不良围插管事件的发生率和特殊情况。
方法:这是对2012年1月1日至2020年12月31日德国直升机EMS数据库的回顾性分析。所有注册患者均纳入主要分析。结果采用SPSS27.0.1.0进行分析。
结果:在总共227,459次紧急医疗响应中,共有18,087例(8.0%)涉及侵入性气道管理.在8141(45.0%)这些患者中,地面EMS工作人员使用气道管理设备,插管率为96.6%(n=7861),使用替代气道的比例为3.2%(n=285)。总的来说,气管插管成功率为94.7%,而管错位形式的不良事件占5.3%,有1.2%的未检测到的食管插管率。在护理人员进行插管后,导管整体错位和未检测到的食管插管更常见(10.4%和3.6%,分别)。鉴于特殊情况,这些错误更经常发生在创伤或心肺复苏的情况下,比率分别为5.6%和6.4%,分别。2.1%(n=213)的HEMS患者存在Cormack4状态的困难气道,在5.2%(n=11)的患者中伴有三次或更多次插管尝试。
结论:近年来,院前气道管理的成功率显著提高。然而,不良的围插管事件,如未检测到的食管插管仍然是对患者安全的持续威胁.
背景:该研究已在德国临床研究注册(编号DRKS00028068)中注册。
BACKGROUND: Prehospital airway management remains crucial with regard to the quality and safety of emergency medical service (EMS) systems worldwide. In 2007, the benchmark study by Timmermann et al. hit the German EMS community hard by revealing a significant rate of undetected oesophageal intubations leading to an often-fatal outcome. Since then, much attention has been given to guideline development and training. This study evaluated the incidence and special circumstances of tube misplacement as an adverse peri-intubation event from a Helicopter Emergency Medical Services perspective.
METHODS: This was a retrospective analysis of a German helicopter-based EMS database from January 1, 2012, to December 31, 2020. All registered patients were included in the primary analysis. The results were analysed using SPSS 27.0.1.0.
RESULTS: Out of 227,459 emergency medical responses overall, a total of 18,087 (8.0%) involved invasive airway management. In 8141 (45.0%) of these patients, airway management devices were used by ground-based EMS staff, with an intubation rate of 96.6% (n = 7861), and alternative airways were used in 3.2% (n = 285). Overall, the rate of endotracheal intubation success was 94.7%, while adverse events in the form of tube misplacement were present in 5.3%, with a 1.2% rate of undetected oesophageal intubation. Overall tube misplacement and undetected oesophageal intubation occurred more often after intubation was carried out by paramedics (10.4% and 3.6%, respectively). In view of special circumstances, those errors occurred more often in the presence of trauma or cardiopulmonary resuscitation, with rates of 5.6% and 6.4%, respectively. Difficult airways with a Cormack 4 status were present in 2.1% (n = 213) of HEMS patients, accompanied by three or more intubation attempts in 5.2% (n = 11).
CONCLUSIONS: Prehospital airway management success has improved significantly in recent years. However, adverse peri-intubation events such as undetected oesophageal intubation remain a persistent threat to patient safety.
BACKGROUND: The study was registered in the German Register for Clinical Studies (number DRKS00028068).