先进的呼吸道实践模式和医院外心脏骤停结果
Michelle M J Nassal1, Betty Y Yang2, Jane Hall3
1Department of Emergency Medicine, The Ohio State University, Columbus.
JAMA network open
|September 17, 2025
概括
在非医院心脏骤停 (OHCA) 护理中,先进的气道 (AA) 实践有所变化,转向超气道 (SGA) 装置. 过渡到SGA使用与表现较差的紧急医疗服务 (EMS) 机构的生存率改善有关.
科学领域:
- 紧急医疗 紧急医疗
- 心脏病学 心脏病学
- 公共卫生 公共卫生
背景情况:
- 先进的呼吸道 (AA) 管理在非医院心脏骤停 (OHCA) 护理中至关重要.
- 紧急医疗服务 (EMS) 机构对AA干预的时间实践模式已经演变.
- 这些不断变化的AA实践模式对OHCA结果的影响仍然不清楚.
研究的目的:
- 调查紧急医疗服务 (EMS) 机构的时间先进呼吸道 (AA) 实践模式与医院外心脏骤停 (OHCA) 结果之间的关联.
- 分析不同AA策略 (内内管管道与上气道) 随着时间的推移如何与患者的生存和自发循环 (ROSC) 的恢复相关.
主要方法:
- 这是一项横截面研究,利用来自心脏骤停注册以提高生存率 (CARES) 数据库的数据.
- 包括成人 (≥18岁) 患有EMS机构治疗的OHCA,每年有≥25次OHCA病例 (2016-2022年).
- 根据AA的主要使用模式,EMS机构被分类为:正在进行的内内管道输入 (ETI),正在进行的上气道 (SGA) 使用,ETI到SGA过渡,以及SGA到ETI过渡.
- 混合效应物流回归模型分析了AA模式和OHCA结果 (ROSC,生存率) 之间的关联,调整了Utstein变量和EMS代理集群.
主要成果:
- 这项研究分析了来自254个EMS机构的350,216名OHCA患者.
- 在EMS机构中,从2016年到2022年,超节气道 (SGA) 的使用增加了.
- 虽然自发循环回归 (ROSC) 在2019年后的所有组都下降了,但从内内管管道 (ETI) 过渡到SGA使用的机构显示ROSC和生存率有所改善,特别是那些基线生存率较低的机构.
结论:
- 随着时间的推移,在急诊医疗服务 (EMS) 中,超气道 (SGA) 设备的使用变得越来越普遍.
- 尽管自发循环回报率 (ROSC) 总体下降,但在表现较差的EMS机构中向SGA使用过渡与更好的结果有关.
- 需要进一步的研究来验证这些发现,并探索它们在不同患者群体中的适用性.
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