院外心脏骤停患者院前高级气道管理成功与失败的比较

IF 4.2 4区 医学 Q1 EMERGENCY MEDICINE
Wataru Takayama, Momoko Sugimoto, Koji Morishita, Yasuhiro Otomo, Nobuya Kitamura, Takashi Tagami
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引用次数: 0

摘要

背景和重要性:虽然在某些情况下,先进的气道管理对院外心脏骤停(OHCA)患者是有益的,但紧急医疗服务(EMS)人员先进的气道管理成功或失败对临床时间过程和结果的影响尚未得到彻底的评估。目的:评价急诊乘务员院前气道管理失败对OHCA患者预后的影响。设计:回顾性多中心注册研究。环境和参与者:回顾了2019年至2021年在日本进行的一项回顾性多中心研究中的OHCA调查数据。结果测量和分析:将接受先进气道管理的患者分为成功组和失败组。评估两组患者的基线特征和预后。通过创建匹配的成功和失败组来进行倾向评分匹配,以分析敏感性。主要预后指标为30天生存率,次要预后指标为出院时良好的神经系统预后、从现场EMS到达医院到到达医院的时间以及自然循环恢复(ROSC)。主要结果:总共分析了4474例院前高级气道管理患者。其中成功组4074例,失败组400例。30天生存率(成功vs失败,4.4 vs 2.3%;P = 0.043)和ROSC (29.9 vs. 16.8%;结论:院前晚期气道管理失败与较低的30天生存率、ROSC以及EMS到达医院的时间较长有关。这些发现表明院前高级气道管理的失败可能会使OHCA患者的预后恶化。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Comparison of outcomes between successful and failed prehospital advanced airway management by paramedic staff in patients with out-of-hospital cardiac arrest.

Background and importance: Although advanced airway management is beneficial for patients with out-of-hospital cardiac arrest (OHCA) in certain situations, the impact of advanced airway management success or failure by the emergency medical service (EMS) crew on the clinical time course and outcomes has not yet been thoroughly evaluated.

Objectives: To evaluate the impact of EMS crew members' prehospital advanced airway management failure on patient outcomes in OHCA.

Design: Retrospective multicentre registry study.

Setting and participants: Data from an OHCA survey in a Japanese retrospective multicentre study conducted between 2019 and 2021 were reviewed.

Outcome measures and analysis: Patients who underwent advanced airway management were divided into success and failure groups. The baseline characteristics and outcomes of the two groups were evaluated. Propensity score matching was performed by creating matched success and failure groups to analyse sensitivity. The primary outcome was 30-day survival, and secondary outcomes were favourable neurological outcomes at discharge, time from on-scene EMS arrival to hospital arrival, and return of spontaneous circulation (ROSC).

Main results: Overall, 4474 patients who underwent prehospital advanced airway management were analysed. Among them, 4074 and 400 patients were in the success and failure groups, respectively. The 30-day survival rates (success vs. failure, 4.4 vs. 2.3%; P = 0.043) and ROSC (29.9 vs. 16.8%; P < 0.001) in the failure group were lower than those in the success group. There were no significant differences in survival rate at hospital discharge (3.6 vs. 2.0%; P = 0.093) and favourable neurological outcomes (1.3 vs. 1.3%; P = 0.930) between the groups. The median time from on-scene EMS arrival to hospital arrival (min) [28.0 (22.0-34.0) vs. 29.0 (25.9-35.0); P < 0.001] in the failure group was longer than that in the success group. After propensity score matching, the results showed a similar trend.

Conclusion: Prehospital advanced airway management failure was associated with lower 30-day survival rates, ROSC, and a longer time between EMS arrival and hospital arrival. These findings suggest that failure of prehospital advanced airway management could potentially worsen the outcomes of patients with OHCA.

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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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