儿科航空医疗气管插管的实践模式与操作表现：一项全国性多中心队列研究

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中文摘要

目的： 儿科院前高级气道管理具有高风险、低频率的特点。既往分析仅限于单一机构的航空医疗团队或地面紧急医疗服务队列。全国范围内的航空医疗操作表现尚未得到充分描述。本研究旨在通过一个全国性多中心队列，描述儿科航空医疗插管的实践模式与结局。
方法： 这是一项回顾性队列研究，纳入2021年至2025年期间由航空医疗团队实施并记录于ImageTrend Collaborate（一个多中心院前临床数据存储库）中的儿科（<18岁）插管病例。首次尝试成功率、总体插管成功率以及尝试后生理状态（定义为首次尝试后10分钟内缺氧、年龄校正低血压和年龄校正心动过缓的复合终点）以n(%)或中位数（IQR）进行总结，并使用卡方检验或Fisher精确检验在四个年龄组（<1岁、1-5岁、6-10岁、11-17岁）之间进行比较。站点层面的药物使用情况在贡献10例及以上病例的站点中进行总结。
结果： 在来自美国四个地区39个贡献站点的1,040例病例中，中位年龄为13岁（IQR 5-16），57.7%涉及创伤或烧伤。77.8%（809/1,040）采用了镇静剂加肌松剂的策略，其中氯胺酮是最常用的诱导药物（43.5%仅用氯胺酮，31.9%仅用依托咪酯）。8.6%的插管记录了视频喉镜的使用。首次尝试成功率为86.5%（898/1,038），总体成功率为93.3%（968/1,038）。操作表现随年龄显著变化：1岁以下婴儿的首次尝试成功率为69.1%（47/68），而青少年为88.7%（535/603）（p < 0.001）；总体成功率分别为80.9%（55/68）和93.9%（566/603）（p < 0.001）；尝试后生理不稳定分别为53.6%（30/56）和31.3%（175/560）（p = 0.008）。尝试后10分钟内ETCO2记录总体为82.8%（861/1,040），婴儿为60.0%（42/70）（p < 0.001）。在13个贡献10例及以上病例的站点中，围尝试期氯胺酮使用比例范围为9%至84%，琥珀酰胆碱使用比例范围为0%至91%。
结论： 在这个全国性多中心航空医疗队列中，总体气道操作表现良好，但1岁以下婴儿的首次尝试成功率较低、总体插管成功率较低，且插管后ETCO2记录频率较低。各贡献站点之间存在显著的实践差异，提示既需要对婴儿亚组进行针对性培训，也需要在站点之间开展基准比较。

英文摘要

OBJECTIVES: Pediatric prehospital advanced airway management is high-stakes and low-frequency. Prior analyses have been limited to single-agency air medical groups or ground emergency medical services cohorts. National air medical performance is not well described. The aim of this study is to characterize practice patterns and outcomes of pediatric air medical intubation across a national multisite cohort.
METHODS: This was a retrospective cohort study of pediatric (< 18 years) intubation encounters performed by air medical crews and recorded in ImageTrend Collaborate, a multisite prehospital clinical data repository, from 2021-2025. First-pass success, overall intubation success, and post-attempt physiology defined as a composite of hypoxia, age-adjusted hypotension, and age-adjusted bradycardia within 10 minutes after index attempt were summarized as n(%) or median (IQR) and compared across four age groups (<1, 1-5, 6-10, 11-17 years) using chi-square or Fisher's exact tests. Site-level medication use was summarized among sites contributing 10 or more encounters.
RESULTS: Among 1,040 encounters from 39 contributing sites across four United States regions, median age was 13 years (IQR 5-16) and 57.7% involved trauma or burn. A sedative-plus-paralytic strategy was used in 77.8% (809/1,040) with ketamine the most common induction agent (43.5% ketamine-only, 31.9% etomidate-only). Video laryngoscopy was documented in 8.6% of intubations. First-pass success was 86.5% (898/1,038) and overall success was 93.3% (968/1,038). Performance varied significantly by age with first-pass success at 69.1% (47/68) in infants under 1 year versus 88.7% (535/603) in adolescents (p < 0.001), overall success 80.9% (55/68) versus 93.9% (566/603) respectively (p < 0.001), and post-attempt physiologic instability 53.6% (30/56) versus 31.3% (175/560) respectively (p = 0.008). Post-attempt ETCO2 within 10 minutes was documented in 82.8% (861/1,040) overall, and 60.0% (42/70) in infants (p < 0.001). Among the 13 sites with 10 or more encounters, peri-attempt ketamine share ranged from 9% to 84% and succinylcholine share from 0% to 91%.
CONCLUSIONS: In this national multisite air medical cohort, overall airway performance was favorable, but infants younger than 1 year had lower first-pass success, lower overall intubation success, and less frequent post-intubation ETCO2 documentation. Substantial practice variation across contributing sites suggests opportunity for both targeted training in the infant subgroup and benchmarking across sites.