Refraining from pre-hospital advanced airway management: a prospective observational study of
critical decision making in an anaesthesiologist-staffed pre-hospital critical care service
Engelsk titel: Refraining from pre-hospital advanced airway management: a prospective observational study of
critical decision making in an anaesthesiologist-staffed pre-hospital critical care service
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Författare:
Rognås, Leif
;
Hansen, Troels Martin
;
Kirkegaard, Hans
;
Tönnesen, Else
Språk: Eng
Antal referenser: 22
Dokumenttyp:
Artikel
UI-nummer: 14129060
Sammanfattning
INTRODUCTION:
We report prospectively recorded observational data from consecutive cases in which the attending
pre-hospital critical care anaesthesiologist considered performing pre-hospital advanced airway
management but decided to withhold such interventions.
MATERIALS AND METHODS:
Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region (a
mixed rural and urban region with 1.27 million inhabitants) registered data from February 1st 2011 to
October 31st 2012. Included were patients of all ages for whom pre-hospital advanced airway
management were considered but not performed. The main objectives were to investigate (1) the
pre-hospital critical care anaesthesiologists' reasons for considering performing pre-hospital
advanced airway management in this group of patients (2) the pre-hospital critical care
anaesthesiologists' reasons for not performing pre-hospital advanced airway management (3) the
methods used to treat these patients (4) the incidence of complications related to pre-hospital
advanced airway management not being performed.
RESULTS:
We registered data from 1081 cases in which the pre-hospital critical care anaesthesiologists'
considered performing pre-hospital advanced airway management. The anaesthesiologists decided
to withhold pre-hospital advanced airway management in 32.1% of these cases (n = 347). In 75.1% of
these cases (n = 257) pre-hospital advanced airway management were withheld because of the
patient's condition and in 30.8% (n = 107) because of patient co-morbidity. The most frequently used
alternative treatment was bag-mask ventilation, used in 82.7% of the cases (n = 287). Immediate
complications related to the decision of not performing pre-hospital advanced airway management
occurred in 0.6% of the cases (n = 2).
CONCLUSION:
We have illustrated the complexity of the critical decision-making associated with pre-hospital
advanced airway management. This study is the first to identify the most common reasons why pre-
hospital critical care anaesthesiologists sometimes choose to abstain from pre-hospital advanced
airway management as well as the alternative treatment methods used.