Air Medical Journal最新文献

Objective

Advanced airway management, including the use of rapid sequence intubation (RSI), is fundamental in resuscitation. However, the reported experience with pediatric airway management is limited because of the relatively low number of emergency RSI procedures in children. The aim of this study was to document the experience with pediatric RSI in a large air medical database and explore opportunities for improvement.

Methods

All pediatric patients (age < 18 years) undergoing RSI by air medical crews between 2015 and 2019 were included in this analysis. Subjects were divided a priori into 3 age subgroups (0-2 years, 3-8 years, and 9-17 years). The primary variables of interest included overall intubation success, first-attempt intubation success, and first-attempt intubation success without desaturation. The rates of positive-pressure ventilation (PPV) use for preoxygenation and oxygen desaturation were also explored.

Results

A total of 1,091 pediatric RSI patients were included. The overall intubation success rate was 98% (0-2 years = 96%, 3-8 years = 97%, and 9-17 years = 98%), with 91% intubated on the first attempt (0-2 years = 86%, 3-8 years = 90%, and 9-17 years = 92%) and 87% intubated on the first attempt without oxygen desaturation (0-2 years = 80%, 3-8 years = 88%, and 9-17 years = 90%). A sharp decline in intubation success was observed with preoxygenation SpO₂ values < 97% across all patients. Younger patients (0-2 years) had lower initial SpO₂ values and decreased first-attempt success rates with and without desaturation. These patients were less likely to receive PPV during preoxygenation attempts and had lower use of video laryngoscopy or a bougie on the initial intubation attempt.

Conclusion

In this study, we documented high success rates for air medical pediatric RSI. Higher target SpO₂ values may be justified during preoxygenation. Intubation success, PPV use for preoxygenation, video laryngoscopy, and the use of a bougie were lower for younger patients.

Drawing from a comprehensive Japan-based literature review and the author's personal experience, this article presents findings that highlight potential improvements in clinical outcomes, such as reduced mortality rates, by optimizing the current resuscitation procedure for cardiopulmonary arrest. Many countries have adopted similar procedures for cardiopulmonary arrest. This article presents a prioritized resuscitation method based on scientific evidence, aiming to improve survival rates. The study, which was conducted in Japan, revealed inconsistencies in the current resuscitation procedure for cardiopulmonary arrest. The study did not involve direct participants but relied on literature review for data collection. A literature review was conducted to analyze the survival rates of various resuscitation methods. The interventions reviewed in the literature included cardiopulmonary resuscitation, automated external defibrillator, and automatic mechanical chest compressions. The survival rate of cardiopulmonary arrest in Japan was found to be low. The results of the literature review suggest that cardiopulmonary resuscitation or automatic mechanical chest compressions should be applied before using an automated external defibrillator. The study emphasizes the need to prioritize resuscitation methods with higher survival rates. This article presents a prioritized resuscitation method based on scientific evidence, aiming to improve survival rates. It is hoped that this new approach will lead to a significant improvement in the survival rates of cardiopulmonary arrest patients.

We present the case of a 10-year-old previously healthy male who suffered an out-of-hospital cardiac arrest because of abdominal trauma and survived with excellent neurologic outcomes and near complete return to baseline functional status at hospital discharge. The rapid response and efficient mobilization of resources led to an excellent patient outcome despite the severity of injuries, including intra-abdominal injuries with expected mortality, out-of-hospital traumatic arrest, coagulopathy, and an extended pediatric intensive care unit stay. This case underscores the significance of timely advanced trauma life support interventions, especially early blood product administration, efficient transport, and airway management, while sharing a remarkable case of out-of-hospital pediatric traumatic arrest with near full recovery.

Objective

Because the unit cost of helicopter emergency medical services (HEMS) is higher than traditional ground-based emergency medical services (EMS), it is important to further investigate the impact of HEMS. The aim of this study was to evaluate the cost-effectiveness of physician-staffed HEMS compared with ground-based EMS in Finland under current practices.

Methods

The incremental cost-effectiveness ratio was evaluated using the differences in outcomes and costs between HEMS and ground-based EMS. The estimated mortality within 30 days and quality-adjusted life years (QALYs) were used to measure health benefits. Quality of life was estimated according to the EuroQoL scale, and a 1-way sensitivity analysis was conducted on the QALY indexes ranging from 0.6 to 0.8. Survival rates were calculated according to the national HEMS database, and the cost structure was estimated at 48 million euros based on financial statements.

Results

HEMS prevented the 30-day mortality of 68.1 patients annually, with an incremental cost-effectiveness ratio of €43,688 to €56,918/QALY. Fixed costs accounted for 93% of HEMS expenses because of 24/7 operations, making the capacity utilization rate a major determinant of total costs.

Conclusion

HEMS intervention is cost-effective compared with ground-based EMS and is acceptable from a societal willingness-to-pay perspective. These findings contribute valuable insights for health care management decision making and highlight the need for future research for service optimization.