Current Status Of Emergency Airway Management In China And Research On Coping Strategies For Related Complication

ObjectiveEndotracheal intubation techniques are widely used in emergency departments.However,complications related to emergency tracheal intubation occurred commonly.Possible reasons are the severe condition of patients and the limited intubation conditions for physicians.There are no extensive data on the types,incidences,and related influencing factors of emergency airway complications in China.The first part of this study conducted a cross-sectional survey on the situation of tracheal intubation in emergency departments across the country,and described the characteristics of patients and operators during the entire intubation process,the use of equipment and drugs,and the incidence of complications,first intubation success rate,and possible influencing factors.The second part screened out a particular situation that is more prone to complications in emergency airway management—difficult airway for in-depth research.This part aimed to describe the incidence of difficult airways in emergency patients and to clarify the predictive value of bedside detection methods in the emergency department for difficult airways.The third part further explored hypoxemia,a high-incidence complication in emergency patients.This part used exhaled oxygen concentration(EtO2)as the main evaluation index to clarify the time and possible influencing factors of passive ventilation in emergency patients before tracheal intubation.MethodsThe first and second part of the dissertation is a cross-sectional questionnaire survey conducted in 41 hospitals selected across the country.The questionnaire included the general characteristics of endotracheal intubation and the status of the difficult airway in emergency departments.REDCap data management platform was used to make,distribute,record,and summarize questionnaires.After the data collection,it was exported to professional statistical software for subsequent processing and chart presentation.The third part is a retrospective study in one hospital.Patients were screened for inclusion in the study through medical records,ventilator and monitor data recording.The average time for patients to achieve the target oxygenation under different inhaled oxygen concentrations baseline and related influencing factors were analyzed.ResultsIn the first part,1020 valid questionnaires were screened out for statistical analysis.It showed that nearly a quarter of emergency intubation patients had a cardiac arrest.Before intubation,97.3%of patients received oxygen therapy,and 48.1%received circulatory treatment.During the intubation,visual equipment was the main device,and the utilization rate of induction drugs was meager:39.9%sedatives,5.5%analgesics,and 5.3%muscle relaxants.The incidence of intubation-related adverse events was 19.8%;among them,hypoxemia was the highest.The first pass success rate of intubation was 85.7%,and the blood pressure decreased significantly after intubation.In the second part,985 patients were screened for statistical analysis.In China,the difficult mask ventilation rate(8.2%)is relatively high,the difficult glottic exposure rate(6.9%),and the difficult endotracheal intubation rate(2.1%)are relatively low.The widespread use of visual intubation equipment(80.6%)may be one of the reasons for the low incidence of difficult airways in China.Emergency bedside physical assessments had certain predictive value for difficult airways,with sensitivity(0.71(95%CI[0.47-0.89]),specificity(0.79 95%CI[0.76-0.81])and area under curve(0.75 95%CI[0.64-0.87],P<0.01).The third part included 113 measurements of exhaled oxygen concentration in 42 patients.The longest median time to ventilation compliance was 79 seconds when setting the baseline inhaled oxygen concentration(FiO2)at 35%.The higher the inhaled oxygen concentration baseline,the shorter the time of the exhaled oxygen concentration reaching the standard.There was a statistical difference for the EtO2 time to target when the FiO2 baseline difference was between 15 and 20%.DiscussionThe incidence of complications related to endotracheal intubation in emergency departments in China is relatively high.Given the low use of induction drugs,it should be standardized in the future.The incidence of difficult airways is relatively low in domestic emergency departments.Although the commonly used difficult airway assessment method has a certain predictive value,it still needs to be improved and optimized with new evaluation indicators.The time for mask ventilation was negatively correlated with the baseline inhaled oxygen concentration before intubation.It should be adjusted according to the patient’s oxygen intake conditions during the mask ventilation.The ventilation effect can be evaluated through EtO2 monitoring if conditions permit.