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A prospective multicenter evaluation of prehospital airway management performance in a large metropolitan region.

机译：对大都市区医院前气道管理绩效的前瞻性多中心评估。

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OBJECTIVES: To determine 1) the success rate of prehospital endotracheal intubation; 2) the unrecognized tube malposition rate; and 3) predictors of tube malposition upon arrival to the emergency department (ED) in the setting of a large metropolitan area that includes 18 hospitals and 34 transporting emergency medical services (EMS) agencies. METHODS: Prospective data were collected on patients for whom prehospital intubation was attempted between September 1, 2004, and January 31, 2005. Endotracheal tube (ETT) position upon arrival to the ED was verified by emergency medicine attending physicians. Missing cases were identified by matching prospective data with lists of attempted intubations submitted by EMS agencies, and data were obtained for these cases by retrospective chart review. Successful intubation was defined as an "endotracheal tube balloon below the cords" on arrival to the ED. Patients were the unit of analysis; proportions with 95% confidence intervals were calculated. RESULTS: Nine hundred twenty-six patients had an attempted intubation. Methods of airway management were determined for 97.5% (825/846) of those transported to a hospital and 33.8% (27/80) of those who died in the field. For transported patients, 74.8% were successfully intubated, 20% had a failed intubation, 5.2% had a malpositioned tube on arrival to the ED, and 0.6% had another method of airway management used. Malpositioned tubes were significantly more common in pediatric patients (13.0%, compared with 4.0% for nonpediatric patients). CONCLUSIONS: Overall intubation success was low, and consistent with previously published series. The frequency of malpositioned ETT was unacceptably high, and also consistent with prior studies. Our data support the need for ongoing monitoring of EMS providers' practices of endotracheal intubation.
机译：目的：确定1）院前气管插管成功率; 2）无法识别的管子错位率; 3）到达大城市地区时到达急诊室（ED）的管子位置不佳的预测因素，该大都市区包括18家医院和34个运送急诊医疗服务（EMS）的机构。方法：收集2004年9月1日至2005年1月31日尝试进行院前插管的患者的前瞻性数据。到达急诊科的气管插管（ETT）位置已由急诊医学主治医师验证。通过将前瞻性数据与EMS机构提交的尝试插管清单进行匹配来识别丢失的病例，并通过回顾性图表审查获得这些病例的数据。成功插管被定义为到达ED时的“脐带下气管导管球囊”。患者是分析的单位;计算具有95％置信区间的比例。结果：962例患者尝试插管。确定了送往医院的患者的97.5％（825/846）和现场死亡的33.8％（27/80）的气道管理方法。对于转运患者，成功插管的比例为74.8％，插管失败的比例为20％，到达急诊室时插管的比例为5.2％，采用另一种气道管理方法的比例为0.6％。放置不当的管在儿科患者中更为常见（13.0％，而非儿科患者为4.0％）。结论：总的插管成功率低，并且与以前发表的系列一致。错位ETT的频率高得令人无法接受，并且与先前的研究一致。我们的数据支持对EMS供应商气管插管实践进行持续监控的需求。

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