Annals of emergency medicine最新文献

Study objective: This study analyzes emergency medicine airway management trends and outcomes among community emergency departments.

Methods: A multicenter, retrospective chart review was conducted on 11,475 intubations from 15 different community emergency departments between January 1, 2015, and December 31, 2022. Data collected included patient's age, sex, rapid sequence intubation medications, use of cricoid pressure, method of intubation, number of attempts, admission diagnosis, and all-cause mortality rates.

Results: Active cardiopulmonary resuscitation occurred in 11.4% of intubations. When rapid sequence intubation was employed, the most frequently used induction agents were etomidate (91.6%), propofol (4.3%), and ketamine (4.1%). From 2015 to 2022, the use of rocuronium (versus succinylcholine) increased from 33.9% to 61.9%, a difference of 28% (95% confidence interval [CI] 21.1% to 34.9%). During the same period, video laryngoscopy (versus direct laryngoscopy) increased from 27.4% to 77.7%, a difference of 50.3% (95% CI 44.2% to 56.4%). Only 46% of intubations used cricoid pressure. Physicians had a first-pass success rate of 80.5% and a failure rate of 0.2%. The most common documented admission diagnoses among intubated patients were respiratory etiologies (27.8%), neurologic causes (21.4%), and sepsis (16.0%). All-cause mortality rates were high for intubated patients at 24 hours (19.7%), 7 days (29.4%), 30 days (38.4%), and 1 year (45.4%).

Conclusion: Physicians intubating in community emergency departments have similar rates of first-pass success and failure seen in academic Level-1 trauma centers despite treating medically sick patients with high all-cause mortality rates. Dramatic shifts in choice of paralytic and method for intubation were seen.

Study objective: The peripheral intravenous catheter (IV) is the most common and painful invasive medical device in acute care settings. Our objective was to determine whether adding skin glue to secure IVs reduced catheter failure rate in children.

Methods: We conducted a randomized controlled trial in a tertiary-care pediatric emergency department (ED). ED patients younger than 18 years old with an IV who were anticipated to be admitted to hospital were eligible for enrollment. Children were randomized to receive standard IV securement with cloth-bordered transparent polyurethane dressing (control) or application of cyanoacrylate glue at the catheter insertion site in addition to standard securement (intervention). Participants were followed until device removal due to failure or physician order. The primary outcome was IV failure before the intended treatment course was complete. Patients who were randomized with primary outcome data were included in the intention-to-treat analysis.

Results: Of the 557 participants enrolled between December 2020 and April 2023, 278 (50%) and 279 (50%) were allocated to the glue and control groups, respectively. A total of 527 participants were included in the intention-to-treat analysis. Intravenous failure rates in the glue and control groups were 83 of 265 (31.3%) and 82 of 262 (31.3%), respectively. The odds of intravenous catheter failure were not different between groups (adjusted odds ratio 0.98; 95% confidence interval, 0.67 to 1.42). Time to device failure was similar between groups (hazard ratio 0.99; 95% confidence interval, 0.73 to 1.35).

Conclusions: This study found no benefit in using skin glue to secure IVs in the ED in children.