ABSTRACT
Objectives: The surgical airway is a high acuity, low occurrence procedure. Data on the complications and outcomes of surgical airways are limited. Our primary objective was to describe immediate complications, late complications, and clinical outcomes of patients who underwent a surgical airway procedure in the prehospital or emergency department (ED) setting. Methods: We conducted a retrospective chart review of patients ≥14 years at an academic medical center who underwent a surgical airway procedure in the ED, the prehospital setting, or at a referring ED prior to interfacility transfer. We identified cases from keyword searches of prehospital text pages and hospital electronic medical records from June 1, 2008 to July 1, 2022. Manual chart review was used to confirm inclusion and determine patient and procedure characteristics. Outcomes included immediate complications, delayed in-hospital complications, and neurologic disability as defined by Modified Rankin Score (mRS) at discharge. Results: We identified 63 patients (34 prehospital, 11 ED, and 18 referring ED). Immediate complications included mainstem intubation (46.0%) and bleeding that required direct pressure (23.4%). Overall, 29 patients (46%) died after arrival to the hospital. Of the patients surviving to hospital admission, 25 (48%) had an airway-related complication. Nine complications were deemed directly related to technical components of the procedure. Of the patients who survived to discharge, 18 (52.9%) had poor neurologic function (mRS 4-5). Conclusion: Procedural complications, mortality, and poor neurologic function were common following a surgical airway procedure in the prehospital or ED setting. Most patients surviving to discharge had a moderate to severe neurologic disability.
Subject(s)
Chest Pain/etiology , Aortic Dissection/complications , Aortic Dissection/diagnosis , Aortic Aneurysm/complications , Aortic Aneurysm/diagnosis , Cardiac Tamponade/complications , Cardiac Tamponade/diagnosis , Diagnosis, Differential , Electrocardiography , Esophageal Perforation/complications , Esophageal Perforation/diagnosis , Humans , Pericarditis/complications , Pericarditis/diagnosis , Pneumothorax/complications , Pneumothorax/diagnosis , Pulmonary Embolism/complications , Pulmonary Embolism/diagnosis , Risk FactorsSubject(s)
Emergency Medical Services , Myocardial Infarction/diagnosis , Aortic Dissection/diagnosis , Aortic Aneurysm/diagnosis , Chest Pain/diagnosis , Chest Pain/etiology , Cocaine-Related Disorders/diagnosis , Diagnosis, Differential , Electrocardiography , Humans , Mediastinal Emphysema/diagnosis , Pericarditis/diagnosis , Pneumothorax/diagnosisABSTRACT
OBJECTIVE: To catalog the 9-1-1 emergency medical services (EMS) transport practices for posttraumatic circulatory arrest patients (PTCAPs) in the majority of the nation's largest municipalities and to compare those practices to guidelines recommended by the National Association of EMS Physicians (NAEMSP) and American College of Surgeons Committee on Trauma (ACSCOT). METHODS: A survey was conducted in 33 of the nation's largest cities primarily to determine whether or not individual EMS systems transport PTCAPs to hospitals and, if so, whether or not the initial electrocardiographic (ECG) rhythm or mechanism of injury affected those transport decisions. RESULTS: All 33 cities (100%) responded. Seven (21%) indicated that EMS would transport an "asystolic blunt trauma patient" emergently or "leave the transport decision to paramedic judgment" despite NAEMSP-ACSCOT guidelines to terminate resuscitation in such cases. Likewise, 15 (46%) of the 33 EMS agencies would transport "asystolic penetrating trauma patients" emergently. Similarly, 27 (82%) would transport penetrating injury patients and 20 (61%) would transport blunt trauma patients with persistent ECG activity but no palpable pulses. However, only five systems had policies that included a minimum ECG heart rate criterion for transport, and all agencies that monitor ECG (n = 32) would transport PTCAPs found with ventricular fibrillation. CONCLUSIONS: Many of the nation's highest volume EMS systems transport certain PTCAPs emergently, contrary to NAEMSP-ACSCOT guidelines to terminate resuscitative efforts in such cases. Reasons for these discrepancies should be evaluated to help better delineate applicable consensus guidelines for large urban EMS agencies.
Subject(s)
Guidelines as Topic , Heart Arrest/therapy , Resuscitation , Transportation of Patients/organization & administration , Wounds and Injuries/complications , Heart Arrest/etiology , Humans , Surveys and Questionnaires , United States , Wounds and Injuries/therapyABSTRACT
The care of the patient with an acute coronary syndrome, specifically STEMI, continues to evolve. Although the goal of caring for any patient with STEMI is a D2B time of less than 90 minutes, research shows that every minute counts, and "time is muscle". Thus, even if a hospital has an acceptable D2B time, EMS on-scene and transport times must be minimized to ensure optimal treatment and recovery of a dying heart. All EMS systems should work with their destination hospitals to ensure E2B times are optimally lowered and aim for an E2B of under 90 minutes when possible. MOreover, a team approach to PCI activation involving both the paramedic and ED physician whenever possible appears to be the best way to decrease false activations and increase recognition of STEMI patients. As research into myocardial infarction and treatment continues, EMS personnel should expect more critical care transports of patients who have already received lytic therapy. The in-hospital care of patients with acute coronary syndromes continues to evolve, and similarly EMS care for ACS patients continues to change at an ever-increasing rate.
