可互换操作员模型在澳大利亚直升机紧急医疗服务中插管的性能特点和并发症

IF 1.7 4区 医学 Q2 EMERGENCY MEDICINE
Alan A Garner MBBS, FACEM, MSc, PhD, Andrew Scognamiglio MD, Dr Anna Lee BPharm, MPH, PhD
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引用次数: 0

摘要

目的采用可互换操作人员模型(ICOM),使护理人员和飞行护士能够在院前重症监护中与团队医生互换插管。然而,关于ICOM特性和性能的文献是有限的。方法:我们对澳大利亚直升机紧急医疗服务机构的ICOM进行了为期9年的回顾性观察研究。比较两组首次插管成功率、主要并发症发生率及临床重要时间间隔。结果413例患者符合纳入标准,其中护理人员首次插管次数最多(379/413,91.8%)。医生主要进行第二次插管尝试和管理高危患者。在未经调整的分析中,护理人员/监督注册员组发生主要并发症的风险不低于最高级医师插管组(相对风险[RR] 0.59, 95%可信区间[CI]: 0.26-1.32;P = 0.198),调整后的风险也没有降低(RR 0.60, 95% CI: 0.24-1.54;p = 0.289)。第一次通过失败分别发生在12例(3.1%)和1例(4.8%)由护理人员/监督注册医师组和大多数资深医师组插管的患者中(P = 0.498)。在接触到插管时间上,护理人员/监督注册第一插管者组与大多数资深医生组的中位数(95% CI)调整差异为- 2分钟(- 7至3分钟;p = 0.392)。两组间调整后的总场景时间也无显著差异(中位数差异为2分钟,95% CI:−3至7;p = 0.500)。结论护理人员在ICOM内进行大多数插管既安全又有效。需要更大规模的研究来检验医生亚组之间的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian helicopter emergency medical service

Performance characteristics and complications of an Inter-Changeable Operator Model for intubation in an Australian helicopter emergency medical service

Objective

The Inter-Changeable Operator Model (ICOM) enables paramedics and flight nurses to perform intubations interchangeably with team physicians in prehospital critical care. However, literature on ICOM characteristics and performance is limited.

Methods

We conducted a retrospective, observational study of an ICOM operating within an Australian Helicopter Emergency Medical Service over a nine-year period. First pass success, major complication rates and clinically important time intervals were compared between first intubator groups.

Results

A total of 413 patients met the inclusion criteria, with paramedics performing the majority of first intubation attempts (379/413, 91.8%). Physicians primarily conducted second intubation attempts and managed high-risk patients. In unadjusted analysis, the risk of major complication in the paramedic/supervised registrar group was not lower than the most senior physician intubator group (relative risk [RR] 0.59, 95% confidence interval [CI]: 0.26–1.32; P = 0.198) and after adjustment the risk was also not lower (RR 0.60, 95% CI: 0.24–1.54; P = 0.289). First pass failure occurred in 12 (3.1%) and 1 (4.8%) patients intubated by paramedic/supervised registrar and most senior physician groups, respectively (P = 0.498). The median (95% CI) adjusted difference in contact to intubation time between paramedic/supervised registrar first intubator and most senior physician groups was −2 min (−7 to 3; P = 0.392). Total adjusted scene time was also not significantly different between groups (median difference 2 min, 95% CI: −3 to 7; P = 0.500).

Conclusions

Paramedics conducting most intubations within an ICOM are both safe and efficient. Larger studies are required to examine differences between physician subgroups.

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来源期刊
Emergency Medicine Australasia
Emergency Medicine Australasia 医学-急救医学
CiteScore
3.70
自引率
13.00%
发文量
217
审稿时长
6-12 weeks
期刊介绍: Emergency Medicine Australasia is the official journal of the Australasian College for Emergency Medicine (ACEM) and the Australasian Society for Emergency Medicine (ASEM), and publishes original articles dealing with all aspects of clinical practice, research, education and experiences in emergency medicine. Original articles are published under the following sections: Original Research, Paediatric Emergency Medicine, Disaster Medicine, Education and Training, Ethics, International Emergency Medicine, Management and Quality, Medicolegal Matters, Prehospital Care, Public Health, Rural and Remote Care, Technology, Toxicology and Trauma. Accepted papers become the copyright of the journal.
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