{"title":"急诊科外快速顺序插管使用不足：急诊医生的见解——一项初步、回顾性观察研究。","authors":"Sung-Yeol Park, Sung-Bin Chon","doi":"10.15441/ceem.24.227","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI is underutilized outside emergency departments (EDs). We compared RSI adoption rates and ETI outcomes outside and within the EDs and investigated whether RSI adoption affected ETI outcomes outside the EDs.</p><p><strong>Methods: </strong>This retrospective study included adults who underwent emergency ETI outside the operating room at one university hospital between March 2022 and February 2023. The exclusion criteria included cardiopulmonary resuscitation, intentional RSI avoidance, and tube exchange via an introducer. The primary outcome was first-pass success rate. Secondary outcomes were multiple attempts (≥3), prolonged ETI (>5 minutes), and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariate logistic regression.</p><p><strong>Results: </strong>A total of 490 ETI cases was included: 286 occurred outside the ED and 204 within the ED. The mean age was 68.3±14.7 years and 290 were male. Cases outside the ED received fewer RSI attempts than cases within the ED (12.6% vs. 86.8%, P<0.001). The former showed fewer incidents of first-attempt success (62.2% vs. 88.2%, P<0.001), more numerous multiple attempts (11.5% vs. 2.0%, P<0.001), longer total time of ETI (8.4±8.3 minutes vs. 2.5±2.5 minutes, P<0.001), and more frequent complications (32.2% vs. 19.6%, P=0.003). However, multivariate logistic regression revealed no significant association between RSI adoption and these outcomes outside the ED: odds ratio, 1.74 (95% confidence interval [CI], 0.783-3.84), 0.167 (95% CI, 0.022-1.30), 1.04 (95% CI, 0.405-2.69), and 1.50 (95% CI, 0.664-3.40), respectively.</p><p><strong>Conclusion: </strong>Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.</p>","PeriodicalId":10325,"journal":{"name":"Clinical and Experimental Emergency Medicine","volume":" ","pages":"139-147"},"PeriodicalIF":1.9000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245651/pdf/","citationCount":"0","resultStr":"{\"title\":\"Underuse of rapid sequence intubation outside emergency departments: preliminary, retrospective, observational study with emergency physician insights.\",\"authors\":\"Sung-Yeol Park, Sung-Bin Chon\",\"doi\":\"10.15441/ceem.24.227\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong>Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI is underutilized outside emergency departments (EDs). We compared RSI adoption rates and ETI outcomes outside and within the EDs and investigated whether RSI adoption affected ETI outcomes outside the EDs.</p><p><strong>Methods: </strong>This retrospective study included adults who underwent emergency ETI outside the operating room at one university hospital between March 2022 and February 2023. The exclusion criteria included cardiopulmonary resuscitation, intentional RSI avoidance, and tube exchange via an introducer. The primary outcome was first-pass success rate. Secondary outcomes were multiple attempts (≥3), prolonged ETI (>5 minutes), and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariate logistic regression.</p><p><strong>Results: </strong>A total of 490 ETI cases was included: 286 occurred outside the ED and 204 within the ED. The mean age was 68.3±14.7 years and 290 were male. Cases outside the ED received fewer RSI attempts than cases within the ED (12.6% vs. 86.8%, P<0.001). The former showed fewer incidents of first-attempt success (62.2% vs. 88.2%, P<0.001), more numerous multiple attempts (11.5% vs. 2.0%, P<0.001), longer total time of ETI (8.4±8.3 minutes vs. 2.5±2.5 minutes, P<0.001), and more frequent complications (32.2% vs. 19.6%, P=0.003). However, multivariate logistic regression revealed no significant association between RSI adoption and these outcomes outside the ED: odds ratio, 1.74 (95% confidence interval [CI], 0.783-3.84), 0.167 (95% CI, 0.022-1.30), 1.04 (95% CI, 0.405-2.69), and 1.50 (95% CI, 0.664-3.40), respectively.</p><p><strong>Conclusion: </strong>Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.</p>\",\"PeriodicalId\":10325,\"journal\":{\"name\":\"Clinical and Experimental Emergency Medicine\",\"volume\":\" \",\"pages\":\"139-147\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12245651/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Clinical and Experimental Emergency Medicine\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.15441/ceem.24.227\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/1/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Clinical and Experimental Emergency Medicine","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.15441/ceem.24.227","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/14 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的：快速顺序插管（RSI）涉及气管插管（ETI）前给药诱导剂和神经肌肉阻滞剂。然而，在急诊科（ED）之外，RSI似乎没有得到充分利用。我们比较了RSI采用率和急诊室内外的ETI结果，并调查了RSI采用率是否影响急诊室外的ETI结果。方法：这项回顾性研究纳入了2022年3月至2023年2月期间在一所大学医院手术室外接受急诊ETI的成年人。排除标准包括心肺复苏术、故意避免RSI和通过介绍器换管。主要结果是第一次通过的成功率。次要结局包括多次（≥3次）尝试、延长（bbb5分钟）ETI和并发症。使用多变量逻辑回归评估RSI采用与ED外结果之间的关系。结果：共纳入ETI 490例：男性290例（68.3±14.7岁），非ED组（286例）RSI发生率低于ED组（204例）：12.6% vs. 86.8% （ppp=0.003）。然而，多变量logistic回归显示，采用RSI与ED以外的结果之间没有显著关联：比值比分别为1.74 [95% CI: 0.783-3.84]、0.167[0.022-1.30]、1.04[0.405-2.69]和1.50[0.664-3.40])。结论：在ED之外，RSI采用率较低，ETI结果较差。然而，在ED之外，RSI采用率与ETI结果之间没有关联。
Underuse of rapid sequence intubation outside emergency departments: preliminary, retrospective, observational study with emergency physician insights.
Objective: Rapid sequence intubation (RSI) involves the administration of induction agents and neuromuscular blockers before endotracheal intubation (ETI). However, RSI is underutilized outside emergency departments (EDs). We compared RSI adoption rates and ETI outcomes outside and within the EDs and investigated whether RSI adoption affected ETI outcomes outside the EDs.
Methods: This retrospective study included adults who underwent emergency ETI outside the operating room at one university hospital between March 2022 and February 2023. The exclusion criteria included cardiopulmonary resuscitation, intentional RSI avoidance, and tube exchange via an introducer. The primary outcome was first-pass success rate. Secondary outcomes were multiple attempts (≥3), prolonged ETI (>5 minutes), and complications. The association between RSI adoption and outcomes outside the ED was assessed using multivariate logistic regression.
Results: A total of 490 ETI cases was included: 286 occurred outside the ED and 204 within the ED. The mean age was 68.3±14.7 years and 290 were male. Cases outside the ED received fewer RSI attempts than cases within the ED (12.6% vs. 86.8%, P<0.001). The former showed fewer incidents of first-attempt success (62.2% vs. 88.2%, P<0.001), more numerous multiple attempts (11.5% vs. 2.0%, P<0.001), longer total time of ETI (8.4±8.3 minutes vs. 2.5±2.5 minutes, P<0.001), and more frequent complications (32.2% vs. 19.6%, P=0.003). However, multivariate logistic regression revealed no significant association between RSI adoption and these outcomes outside the ED: odds ratio, 1.74 (95% confidence interval [CI], 0.783-3.84), 0.167 (95% CI, 0.022-1.30), 1.04 (95% CI, 0.405-2.69), and 1.50 (95% CI, 0.664-3.40), respectively.
Conclusion: Outside the ED, RSI adoption was lower and ETI outcomes were poorer than those within the ED. However, no association was found between RSI adoption and ETI outcomes outside the ED.
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