1. Indikationen und Erfolgsrate der endotrachealen Notfallintubation in der klinischen Akut- und Notfallmedizin.
- Author
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Rödler, Jana Vienna, Hilgers, Sabrina, Rüppel, Marc, Föhr, Philipp, Hohn, Andreas, Chorianopoulos, Emmanuel, and Bergrath, Sebastian
- Subjects
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MEDICAL consultants , *CRITICALLY ill , *PATIENTS , *TREATMENT effectiveness , *RETROSPECTIVE studies , *HOSPITAL emergency services , *ROCURONIUM bromide , *DESCRIPTIVE statistics , *CATHETERIZATION , *TRACHEA intubation , *LARYNGOSCOPY , *HOSPITAL medical staff , *LUNG surgery , *CARDIOPULMONARY resuscitation , *AIRWAY (Anatomy) , *CARDIAC arrest , *PHARMACODYNAMICS , *DISEASE risk factors - Abstract
Background: Securing the airway in the emergency department (ED) is a high-stakes procedure; however, the primary success and complication rate are largely unknown in Germany. The aim of this study was a retrospective analysis of prospectively collected resuscitation room data for endotracheal intubation (ETI) regarding indications, performance and complications. Method: Between 1 January 2020 and 30 June 2023 all ETIs conducted in the ED (Kliniken Maria Hilf, Moenchengladbach, Germany) were analyzed following approval by the ethics committee (EK 23-369). Primary intubations performed by the anesthesiology department were excluded. The core medical team of the ED underwent a six-week training program including a two-week anesthesia rotation prior to performing ETI in the ED. There were standard operating procedures (SOP) for both rapid sequence induction (RSI) and airway exchange with a placed laryngeal tube (LT) utilizing video laryngoscopy (C-Mac, Storz), rocuronium for relaxation and primary intubation with an elastic bougie. The primary success rate, overall success rate and intubation-related complications were analyzed. Additionally, the factor of consultant ED staff and residents was evaluated with respect to the primary success rate. Results: During the study period 499 patients were intubated by the core ED team and 28 patients underwent airway exchange from LT to ETI. Primary success could be achieved in 489/499 (98.0%) ETI and in 25/28 (89.3%) LT exchange patients. Surgically achieved securing of the airway was carried out in 5/527 (0.9%) patients in a cannot intubate situation and 11/527 (2.2%) patients suffered cardiac arrest minutes after the ETI. The overall first pass success rate of endotracheal tube placement was 514/527 (97.4%). The comparison of the primary success of consultants (168/175; 96.0%) vs. residents 320/325 (98.5%) yielded no significant differences (p = 0.08). Conclusion: In clinical acute and emergency medicine, a standardized approach utilizing video laryngoscopy and a bougie following a structured training concept, can achieve an above-average high primary success rate with simultaneous low severe complications in the high-risk collective of critically ill emergency patients in an intrahospital setting. [ABSTRACT FROM AUTHOR]
- Published
- 2024
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