Patient safety in pre-hospital emergency tracheal intubation a comprehensive meta-analysis of the intubation success rates of EMS providers 英文参考文献.docVIP
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Patient safety in pre-hospital emergency tracheal intubation a comprehensive meta-analysis of the intubation success rates of EMS providers 英文参考文献
Lossiusetal.CriticalCare2012,16:R24
/content/16/1/R24
RESEARCH
OpenAccess
Patientsafetyinpre-hospitalemergencytracheal
intubation:acomprehensivemeta-analysisofthe
intubationsuccessratesofEMSproviders
HansMortenLossius1,2*,JoR?islien1,3 andDavidJLockey4,5
Abstract
Introduction:Pre-hospitalairwaymanagementisacontroversialsubject,butthereisgeneralagreementthata
smallnumberofseriouslyillorinjuredpatientsrequireurgentemergencytrachealintubation(ETI)andventilation.
ManyEuropeanemergencymedicalservices(EMS)systemsprovidephysicianstocareforthesepatientswhile
othersystemsrelyonparamedics(or,rarely,nurses).TheETIsuccessrateisanimportantmeasureofproviderand
EMSsystemsuccessandamarkerofpatientsafety.
Methods:WeconductedasystematicsearchofMedlineandEMBASEtoidentifyallofthepublishedoriginal
English-languagearticlesreportingpre-hospitalETIinadultpatients.WeselectedallofthestudiesthatreportedETI
successratesandextractedinformationonthenumberofattemptedandsuccessfulETIs,typeofprovider,levelof
ETItrainingandtheavailabilityofdrugsonscene.Wecalculatedtheoverallsuccessrateusingmeta-analysisand
assessedtherelationshipsbetweentheETIsuccessrateandtypeofproviderandbetweentheETIsuccessrateand
thetypesofdrugsavailableonthescene.
Results:From1,070studiesinitiallyretrieved,weidentified58originalstudiesmeetingtheselectioncriteria.Sixty-
fourpercentofthenon-physician-mannedservicesand54%ofthephysician-mannedservicesreportedETI
successratesbutthesuccessratereportingwasincompleteinthreestudiesfromnon-physician-mannedservices.
Mediansuccessratewas0.905(0.491,1.000).Inaweightedlinearregressionanalysis,physiciansasproviderswere
significantlyassociatedwithincreasedsuccessrates,0.092(P=0.0345).Inthenon-physiciangroup,theuseof
drug-assistedintubationsignificantlyincreasedthesuccessrates.Allphysicianshadaccesstotraditionalrapid
sequenceinduction(RSI)and,comparingthesetonon-physiciansusingmuscleparalyticsoratraditionalRSI,there
stillwasasignificantdifferenceinsuccessrateinfavourofphysicians,0.991and0.9
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