[Indications and success rate of endotracheal emergency intubation in clinical acute and emergency medicine].

Die Anaesthesiologie Pub Date : 2024-08-01 Epub Date: 2024-08-02 DOI:10.1007/s00101-024-01444-y
Jana Vienna Rödler, Sabrina Hilgers, Marc Rüppel, Philipp Föhr, Andreas Hohn, Emmanuel Chorianopoulos, Sebastian Bergrath
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引用次数: 0

Abstract

Background: Securing the airway in the emergency department (ED) is a high-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was a retrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications.

Method: Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent a six-week training program including a two-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with a placed laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate.

Results: During the study period 499 patients were intubated by the core ED team and 28 patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527 (2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08).

Conclusion: In clinical acute and emergency medicine, a standardized approach utilizing video laryngoscopy and a bougie following a structured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting.

[临床急诊医学中气管内紧急插管的适应症和成功率]。
背景:在急诊科(ED)中确保气道安全是一项关系重大的手术;然而,在德国,主要的成功率和并发症发生率在很大程度上并不为人所知。本研究旨在对前瞻性收集的复苏室气管插管(ETI)数据进行回顾性分析,分析其适应症、效果和并发症:在获得伦理委员会批准(EK 23-369)后,对 2020 年 1 月 1 日至 2023 年 6 月 30 日期间在急诊室(德国门兴格拉德巴赫玛丽亚-希尔夫医院)进行的所有 ETI 进行了分析。不包括麻醉科进行的初次插管。在急诊室实施 ETI 之前,急诊室的核心医疗团队接受了为期六周的培训,其中包括为期两周的麻醉轮转。快速序列诱导(RSI)和气道交换都有标准操作程序(SOP),使用视频喉镜(C-Mac,Storz)置入喉管(LT),使用罗库溴铵放松,并使用弹性通气导管进行初级插管。对初次成功率、总体成功率和插管相关并发症进行了分析。此外,还评估了急诊室顾问人员和住院医生对主要成功率的影响:研究期间,急诊室核心团队为 499 名患者进行了插管,28 名患者从 LT 到 ETI 进行了气道交换。489/499例(98.0%)ETI患者和25/28例(89.3%)LT气道置换患者获得了初步成功。在无法插管的情况下,5/527(0.9%)名患者通过手术实现了气道固定,11/527(2.2%)名患者在 ETI 结束几分钟后心脏骤停。气管插管的总体首次成功率为 514/527(97.4%)。顾问(168/175;96.0%)与住院医师(320/325;98.5%)的首次成功率比较无显著差异(P = 0.08):结论:在临床急诊医学中,根据结构化培训理念,使用视频喉镜和通气导管的标准化方法,可在院内危重急诊病人的高风险集体中实现高于平均水平的高初次成功率,并同时降低严重并发症。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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