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

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.doc

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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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