The Effect of Prehospital Protocol Modification during COVID-19 on First-Pass Intubation Success Rates.

IF 2.1 4区医学 Q2 EMERGENCY MEDICINE

Prehospital and Disaster Medicine Pub Date : 2025-04-02 DOI:10.1017/S1049023X25000238

Abagayle E Bierowski, Paul C Comber, Alexander Kuc, Aman Shah, Gerard Carroll

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引用次数: 0

Abstract

Introduction: Many Emergency Medical Services (EMS) agencies modified their protocols during the height of the COVID-19 pandemic, particularly those involving procedures that lead to an increased risk of airborne exposure, such as intubation. In 2020, local Advanced Life Support (ALS) providers' first-line airway management device was the supraglottic airway (SGA), and tracheal intubations (TIs) were rarely performed.

Objective: This study's aim was to investigate the potential clinical effect of this pandemic-related protocol change on first-pass TI success rates and on overall initial advanced airway placement success.

Methods: This study was a retrospective prehospital chart review for all ALS encounters from a single urban EMS agency that resulted in the out-of-hospital placement of at least one advanced airway per encounter from January 1, 2019 through June 30, 2021 (n = 452). Descriptive statistics and chi square tests were used to evaluate data. Statistical significance was defined at P < .05.

Results: Significantly fewer TIs were attempted in 2020 (n = 16) compared to 2019 (n = 80; P < .001), and first-pass TI success rates significantly decreased in 2021 (n = 22; 61.1%) compared to 2019 (n = 63; 78.8%; P = .047). Also, SGA placement constituted 91.2% of all initial airway management attempts in 2020 (n = 165), more than both 2019 (n = 114; 58.8%; P < .001) and 2021 (n = 87; 70.7%; P < .001). Overall first-attempt advanced airway placement success, encompassing both supraglottic and TI, increased from 2019 (n = 169; 87.1%) to 2020 (n = 170; 93.9%; P = .025). Conversely, overall first attempt advanced airway placement success decreased from 2020 to 2021 (n = 104; 84.6%; P = .0072).

Conclusions: Lack of exposure to TI during the COVID-19 pandemic likely contributed to this local agency's decreased first-pass TI success in 2021. Moving forward, agencies should utilize simulation labs and other continuing education efforts to help maintain prehospital providers' proficiency in performing this critical procedure, particularly when protocol changes temporarily hinder or prohibit field-based psychomotor skill development.

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COVID-19期间院前方案修改对首次插管成功率的影响

导论：许多紧急医疗服务（EMS）机构在2019冠状病毒病（COVID-19）大流行最严重期间修改了其规程，特别是那些涉及导致空气传播暴露风险增加的程序，如插管。2020年，当地高级生命支持（ALS）提供者的一线气道管理设备是声门上气道（SGA），气管插管（TIs）很少进行。目的：本研究的目的是调查与大流行相关的方案变更对首次通过TI成功率和总体初始晚期气道放置成功率的潜在临床影响。方法：本研究是对2019年1月1日至2021年6月30日期间来自单一城市EMS机构的所有ALS就诊情况（n = 452）进行回顾性院前图表回顾，这些就诊导致每次就诊至少一个先进气道的院外安置。采用描述性统计和卡方检验对数据进行评价。P < 0.05为差异有统计学意义。结果：与2019年(n = 80；P < 0.001)， 2021年首次通过的TI成功率显著下降(n = 22；61.1%)，与2019年相比(n = 63；78.8%;P = .047)。此外，SGA放置占2020年所有初始气道管理尝试的91.2% (n = 165)，高于2019年(n = 114；58.8%;P < 0.001)和2021年(n = 87；70.7%;P < 0.001)。总体首次尝试先进气道置入成功率，包括声门上和TI，自2019年以来有所增加(n = 169；87.1%)至2020年(n = 170；93.9%;P = .025)。相反，总体首次尝试高级气道置入成功率从2020年下降到2021年(n = 104；84.6%;P = .0072)。结论：在COVID-19大流行期间缺乏对TI的接触可能导致该当地机构在2021年首次通过TI的成功率下降。今后，各机构应利用模拟实验室和其他继续教育努力来帮助维持院前提供者在执行这一关键程序方面的熟练程度，特别是当协议变更暂时阻碍或禁止基于现场的精神运动技能发展时。

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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来源期刊

Prehospital and Disaster Medicine Medicine-Emergency Medicine

CiteScore

3.10

自引率

13.60%

发文量

279

期刊介绍： Prehospital and Disaster Medicine (PDM) is an official publication of the World Association for Disaster and Emergency Medicine. Currently in its 25th volume, Prehospital and Disaster Medicine is one of the leading scientific journals focusing on prehospital and disaster health. It is the only peer-reviewed international journal in its field, published bi-monthly, providing a readable, usable worldwide source of research and analysis. PDM is currently distributed in more than 55 countries. Its readership includes physicians, professors, EMTs and paramedics, nurses, emergency managers, disaster planners, hospital administrators, sociologists, and psychologists.