院前先进气道管理对实用气道复苏试验中动脉血气的影响

IF 2.4 Q3 CRITICAL CARE MEDICINE

Resuscitation plus Pub Date : 2025-06-26 DOI:10.1016/j.resplu.2025.101018

Grace C. Sullivan , Henry E. Wang , Christopher B. Gage , Jonathan R. Powell , Elisabete Aramendi , Xabier Jaureguibeitia , Andoni Elola , Ahamed Idris , Mohamud R. Daya , Shannon W. Stephens , Jestin N. Carlson , Graham Nichol , Tom P. Aufderheide , Ashish R. Panchal , Michelle M.J. Nassal

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引用次数: 0

摘要

先进的气道设备有助于院外心脏骤停（OHCA）期间的通气和氧合。先进气道设备之间气体交换的差异尚不清楚。目的探讨实用气道复苏试验（PART）中喉管（LT）和气管插管（ETI）患者的动脉血气（ABG）变化特点。方法纳入在急诊科（ED）到达后≤1.5 h采集ABG的成人ohca。我们收集了1)最后一次院前气道技术2)ABG测量值（pH, PaO2, PaCO2）和3)院前最后5分钟的平均潮汐末血糖（EtCO2）值。我们使用Mann-Whitney检验比较气道类型、ABG值和PaCO2-EtCO2绝对差值（PaCO2-EtCO2），按循环状态分层。我们还测定了院前EtCO2和ED PaCO2的相关性。结果3004例患者中，401例符合纳入标准，其中LT 272例，ETI 129例。在恢复自然循环（ROSC）的病例中，pH值（7.1 vs 7.2, p = 0.10）和PaO2 （142 vs 170 mmHg, p = 0.08）没有差异。LT患者PaCO2高于ETI患者（58 vs 50 mmHg, p = 0.003）。在没有ROSC的病例中，pH （7.0 vs. 7.0, p = 0.55）和PaCO2 （64 vs. 61 mmHg, p = 0.58）没有差异，但LT的PaO2低于ETI （85 vs. 123 mmHg, p = 0.03）。在任何气道装置/ROSC组合中，EtCO2与PaCO2均无相关性。与ROSC患者相比，LT和ETI非ROSC患者的PaCO2-EtCO2差异更大（27 vs 18 mmHg, p = 0.03）。结论院前先进气道管理方法可能改变sabg值。OHCA患者EtCO2与PaCO2的相关性尚不清楚。

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Effect of prehospital advanced airway management on arterial blood gases in the pragmatic airway resuscitation trial

Background

Advanced airway devices facilitate ventilation and oxygenation during out-of-hospital cardiac arrest (OHCA). Differences in gas exchange between advanced airway devices are unknown.

Objective

Characterize arterial blood gases (ABG) in laryngeal tube (LT) or endotracheal intubation (ETI) cases in the Pragmatic Airway Resuscitation Trial (PART).

Methods

We included adult OHCAs with ABG collected ≤ 1.5 h after emergency department (ED) arrival. We collected 1) last prehospital airway technique used 2) ABG measurements (pH, PaO₂, PaCO₂), and 3) average prehospital end-tidal capnography (EtCO₂) values for the last five minutes. We compared airway types, ABG values, and PaCO₂-EtCO₂ absolute difference (PaCO₂-EtCO₂) using the Mann-Whitney test, stratifying by circulation status. We also determined prehospital EtCO₂ and ED PaCO₂ correlation.

Results

Of 3004 cases, 401 met inclusion with 272 LT and 129 ETI. Among cases achieving return of spontaneous circulation (ROSC), pH (7.1 vs. 7.2, p = 0.10) and PaO₂ (142 vs 170 mmHg, p = 0.08) did not differ. PaCO₂ was higher in LT than ETI (58 vs 50 mmHg, p = 0.003). Among cases without ROSC, pH (7.0 vs. 7.0, p = 0.55) and PaCO₂ (64 vs. 61 mmHg, p = 0.58) did not differ, but PaO₂ was lower in LT than ETI (85 vs. 123 mmHg, p = 0.03). EtCO₂ did not correlate with PaCO₂ in any airway device/ROSC combination. PaCO₂-EtCO₂ difference was wider in both LT and ETI non-ROSC cases compared to ROSC cases (27 vs 18 mmHg, p = 0.03).