Prehospital Drug Assisted Airway Management: An NAEMSP Position Statement and Resource Document

被引:9
作者
Jarvis, Jeffrey L. [1 ,2 ]
Lyng, John W. [3 ,6 ]
Miller, Brian L. [4 ,5 ]
Perlmutter, Michael C. [6 ]
Abraham, Heidi [7 ]
Sahni, Ritu [8 ,9 ,10 ]
机构
[1] Williamson Cty EMS, Georgetown, TX 78626 USA
[2] Texas A&M Coll Med, Baylor Scott & White, Temple, TX 76508 USA
[3] Univ Minnesota, Med Sch, Minneapolis, MN USA
[4] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA
[5] MedStar Mobile Healthcare, Metropolitan Area EMS Author, Ft Worth, TX USA
[6] North Mem Hlth Air Care, Brooklyn Ctr, MN USA
[7] Austin Travis Cty EMS, Austin, TX USA
[8] Clackamas Cty EMS, Oregon City, OR USA
[9] Washington Cty EMS, Hillsboro, OR USA
[10] Oregon Hlth & Sci Univ, Portland, OR 97201 USA
关键词
prehospital; out-of-hospital; airway management; rapid sequence intubation; rapid sequence airway; delayed sequence airway; apneic oxygenation; capnography; RAPID-SEQUENCE INTUBATION; EMERGENCY-DEPARTMENT; CARDIAC-ARREST; ENDOTRACHEAL INTUBATION; FACEMASK VENTILATION; HEAD-INJURY; NEUROMUSCULAR BLOCKADE; TRACHEAL INTUBATION; INCREASED MORTALITY; APNEIC OXYGENATION;
D O I
10.1080/10903127.2021.1990447
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Airway management is a critical intervention for patients with airway compromise, respiratory failure, and cardiac arrest. Many EMS agencies use drug-assisted airway management (DAAM) - the administration of sedatives alone or in combination with neuromuscular blockers - to facilitate advanced airway placement in patients with airway compromise or impending respiratory failure who also have altered mental status, agitation, or intact protective airway reflexes. While DAAM provides several benefits including improving laryngoscopy and making insertion of endotracheal tubes and supraglottic airways easier, DAAM also carries important risks. NAEMSP recommends: DAAM is an appropriate tool for EMS clinicians in systems with clear guidelines, sufficient training, and close EMS physician oversight. DAAM should not be used in settings without adequate resources. EMS physicians should develop clinical guidelines informed by evidence and oversee the training and credentialing for safe and effective DAAM. DAAM programs should include best practices of airway management including patient selection, assessmenct and positioning, preoxygenation strategies including apneic oxygenation, monitoring and management of physiologic abnormalities, selection of medications, post-intubation analgesia and sedation, equipment selection, airway confirmation and monitoring, and rescue airway techniques. Post-DAAM airway placement must be confirmed and continually monitored with waveform capnography. EMS clinicians must have the necessary equipment and training to manage patients with failed DAAM, including bag mask ventilation, supraglottic airway devices and surgical airway approaches. Continuous quality improvement for DAAM must include assessment of individual and aggregate performance metrics. Where available for review, continuous physiologic recordings (vital signs, pulse oximetry, and capnography), audio and video recordings, and assessment of patient outcomes should be part of DAAM continuous quality improvement.
引用
收藏
页码:42 / 53
页数:12
相关论文
共 134 条
[1]   LATENCY OF PULSE OXIMETRY SIGNAL WITH USE OF DIGITAL PROBES ASSOCIATED WITH INAPPROPRIATE EXTUBATION DURING PREHOSPITAL RAPID SEQUENCE INTUBATION IN HEAD INJURY PATIENTS: CASE EXAMPLES [J].
Aguilar, Steve A. ;
Davis, Daniel P. .
JOURNAL OF EMERGENCY MEDICINE, 2012, 42 (04) :424-428
[2]   The Effects of a Shoulder Roll During Laryngoscopy in Infants: A Randomized, Single-Blinded, Crossover Study [J].
Alfahel, Waseem ;
Gopinath, Anupama ;
Arheart, Kristopher L. ;
Gensler, Tara ;
Lerman, Jerrold .
ANESTHESIA AND ANALGESIA, 2020, 131 (04) :1210-1216
[3]   CLINICAL CREDENTIALING OF EMS PROVIDERS [J].
不详 .
PREHOSPITAL EMERGENCY CARE, 2017, 21 (03) :397-398
[4]   Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study [J].
April, Michael D. ;
Arana, Allyson ;
Reynolds, Joshua C. ;
Carlson, Jestin N. ;
Davis, William T. ;
Schauer, Steven G. ;
Oliver, Joshua J. ;
Summers, Shane M. ;
Long, Brit ;
Walls, Ron M. ;
Brown, Calvin A. .
RESUSCITATION, 2021, 162 :403-411
[5]   Emergency Department Intubation Success With Succinylcholine Versus Rocuronium: A National Emergency Airway Registry Study [J].
April, Michael D. ;
Arana, Allyson ;
Pallin, Daniel J. ;
Schauer, Steven G. ;
Fantegrossi, Andrea ;
Fernandez, Jessie ;
Maddry, Joseph K. ;
Summers, Shane M. ;
Antonacci, Mark A. ;
Brown, Calvin A., III .
ANNALS OF EMERGENCY MEDICINE, 2018, 72 (06) :645-+
[6]   Ketamine as a Rapid Sequence Induction Agent in the Trauma Population: A Systematic Review [J].
Baekgaard, Josefine S. ;
Eskesen, Trine G. ;
Sillesen, Martin ;
Rasmussen, Lars S. ;
Steinmetz, Jacob .
ANESTHESIA AND ANALGESIA, 2019, 128 (03) :504-510
[7]   Noninvasive ventilation improves preoxygenation before intubation of hypoxic patients [J].
Baillard, Christophe ;
Fosse, Jean-Philippe ;
Sebbane, Mustapha ;
Chanques, Gerald ;
Vincent, Francois ;
Courouble, Patricia ;
Cohen, Yves ;
Eledjam, Jean-Jacques ;
Adnet, Frederic ;
Jaber, Samir .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2006, 174 (02) :171-177
[8]   Apneic oxygenation during intubation in the emergency department and during retrieval: A systematic review and meta-analysis [J].
Binks, Matthew J. ;
Holyoak, Rhys S. ;
Melhuish, Thomas M. ;
Vlok, Ruan ;
Bond, Elyse ;
White, Leigh D. .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2017, 35 (10) :1542-1546
[9]   Incidence and Duration of Continuously Measured Oxygen Desaturation During Emergency Department Intubation [J].
Bodily, Jerry B. ;
Webb, Heather R. ;
Weiss, Steve J. ;
Braude, Darren A. .
ANNALS OF EMERGENCY MEDICINE, 2016, 67 (03) :389-395
[10]   Impact of Video Laryngoscopy on Advanced Airway Management by Critical Care Transport Paramedics and Nurses Using the CMAC Pocket Monitor [J].
Boehringer, Bradley ;
Choate, Michael ;
Hurwitz, Shelley ;
Tilney, Peter V. R. ;
Judge, Thomas .
BIOMED RESEARCH INTERNATIONAL, 2015, 2015