Browsing by Subject "airway management"

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  • Saviluoto, Anssi; Jäntti, Helena; Kirves, Hetti Anna; Setälä, Piritta; Nurmi, Jouni (2022)
    Background: Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management. Methods: We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0-12), intermediate (13-36), and high (>= 37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension. Results: In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64-0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th-75th percentile: 22-38], compared with intermediate 32 [23-42] and lowest 32 [23-43] case-volume groups; P Conclusions: Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.
  • Gellerfors, M.; Fevang, E.; Bäckman, A.; Krüger, A.; Mikkelsen, S.; Nurmi, J.; Rognås, L.; Sandström, E.; Skallsjö, G.; Svensén, C.; Gryth, D.; Lossius, H.M. (2018)
    Background: Pre-hospital tracheal intubation success and complication rates vary considerably among provider categories. The purpose of this study was to estimate the success and complication rates of pre-hospital tracheal intubation performed by physician anaesthetist or nurse anaesthetist pre-hospital critical care teams. Methods: Data were prospectively collected from critical care teams staffed with a physician anaesthetist or a nurse anaesthetist according to the Utstein template for pre-hospital advanced airway management. The patients served by six ambulance helicopters and six rapid response vehicles in Denmark, Finland, Norway, and Sweden from May 2015 to November 2016 were included. Results: The critical care teams attended to 32 007 patients; 2028 (6.3%) required pre-hospital tracheal intubation. The overall success rate of pre-hospital tracheal intubation was 98.7% with a median intubation time of 25 s and an on-scene time of 25 min. The majority (67.0%) of the patients' tracheas were intubated by providers who had performed >2500 tracheal intubations. The success rate of tracheal intubation on the first attempt was 84.5%, and 95.9% of intubations were completed after two attempts. Complications related to pre-hospital tracheal intubation were recorded in 10.9% of the patients. Intubations after rapid sequence induction had a higher success rate compared with intubations without rapid sequence induction (99.4% vs 98.1%; P=0.02). Physicians had a higher tracheal intubation success rate than nurses (99.0% vs 97.6%; P=0.03). Conclusions: When performed by experienced physician anaesthetists and nurse anaesthetists, pre-hospital tracheal intubation was completed rapidly with high success rates and a low incidence of complications.
  • Ljungqvist, Harry; Nurmi, Jouni (Helsingin yliopisto, 2021)
    Bakgrund: Vid rutinmässig användning av C-MAC videolaryngoskop samt Frova introducer uppnår man en hög procent av lyckade intubationer på första försöket. Vi strävade i denna studie till att identifiera potentiella orsaker samt undergrupper av patienter associerade med misslyckade intubationsförsök. Vi ville även utreda vilka åtgärder som vidtagits efter de misslyckade försöken samt om det uppstod några komplikationer. Metoder: Vi genomförde en retrospektiv observationell studie av vuxna intuberade patienter hos en läkarhelikopterenhet i södra Finland under åren 2016 till 2018. Ur ett nationellt läkarhelikopterregister samt ur de prehospitala patienttexterna samlade vi omfattande data gällande demografi och patient egenskaper, beskrivna orsaker till de misslyckade försöken, möjliga komplikationer och åtgärder efter ett misslyckat försök. Resultat: 1011 intubationer utfördes. I 994 av fallen lyckades intubationen på det första försöket (994/1011, 98,3%), 15 lyckades på det andra eller tredje försöket och i två fall krävdes en kirurgisk andningsväg (17/1011, 1,7%, 95% CI 1.0–2.7). Vanligaste orsaken till ett misslyckat intubations försök var en obstruktion av luftvägen på grund av maginnehåll, slem eller blod (10/13, 76%). Efter ett misslyckat försök avvek sex av fallen från de föreskrivna riktlinjerna (6/14, 43%) medan de vanligaste komplikationerna var hypoxi (5/17, 29%) samt hypotension (4/17, 24%) Slutsatser: När man använder ett intubations protokoll som inkluderar rutinmässig användning av C-MAC videolaryngoskop samt Frova introducer, är den vanligaste orsaken till ett misslyckat försök en obstruktion av luftvägen på grund av maginnehåll, slem eller blod. Dessa fynd markerar vikten av effektiva metoder för rengörning av luftvägen samt ifrågasätter lämpligheten av en mera anatomifokuserad bedömning av luftvägen inför intubering.