Background

Pre-hospital anaesthesia is a core competency of helicopter emergency medical services (HEMS). Whether physician pre-hospital anaesthesia case volume affects outcomes is unknown in this setting. We aimed to investigate whether physician case volume was associated with differences in mortality or medical management.

Methods

We conducted a registry-based cohort study of patients undergoing drug-facilitated intubation by HEMS physician from January 1, 2013 to August 31, 2019. The primary outcome was 30-day mortality, analysed using multivariate logistic regression controlling for patient-dependent variables. Case volume for each patient was determined by the number of pre-hospital anaesthetics the attending physician had managed in the previous 12 months. The explanatory variable was physician case volume grouped by low (0–12), intermediate (13–36), and high (≥37) case volume. Secondary outcomes were characteristics of medical management, including the incidence of hypoxaemia and hypotension.

Results

In 4818 patients, the physician case volume was 511, 2033, and 2274 patients in low-, intermediate-, and high-case-volume groups, respectively. Higher physician case volume was associated with lower 30-day mortality (odds ratio 0.79 per logarithmic number of cases [95% confidence interval: 0.64–0.98]). High-volume physician providers had shorter on-scene times (median 28 [25th–75th percentile: 22–38], compared with intermediate 32 [23–42] and lowest 32 [23–43] case-volume groups; P<0.001) and a higher first-pass success rate for tracheal intubation (98%, compared with 93% and 90%, respectively; P<0.001). The incidence of hypoxaemia and hypotension was similar between groups.

Conclusions

Mortality appears to be lower after pre-hospital anaesthesia when delivered by physician providers with higher case volumes.

中文翻译：

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院前麻醉管理中病例量与死亡率之间的关联：回顾性观察队列

背景

院前麻醉是直升机紧急医疗服务（HEMS）的核心能力。在这种情况下，医生的院前麻醉病例数是否会影响结果尚不清楚。我们的目的是调查医生病例量是否与死亡率或医疗管理差异相关。

方法

我们对 2013 年 1 月 1 日至 2019 年 8 月 31 日期间由 HEMS 医生接受药物辅助插管的患者进行了一项基于登记的队列研究。主要结局是 30 天死亡率，使用控制患者相关变量的多变量逻辑回归进行分析。每个患者的病例量由主治医生在过去 12 个月内使用的院前麻醉剂数量决定。解释变量是医生病例量，按低病例量（0-12）、中病例量（13-36）和高病例量（≥37）分组。次要结局是医疗管理的特征，包括低氧血症和低血压的发生率。

结果

在 4818 名患者中，低病例量组、中病例量组和高病例量组的医生病例量分别为 511 例、2033 例和 2274 例患者。医师病例数越高，30 天死亡率越低（每对数病例数的比值比为 0.79 [95% 置信区间：0.64–0.98]）。高处理量的医生提供者的现场时间较短（中位数为 28 [25%–75%：22–38]，而病例量组为中间 32 [23–42] 和最低 32 [23–43]；P < 0.001 ）和更高的气管插管首次通过成功率（98%，分别为 93% 和 90%；P <0.001）。各组之间低氧血症和低血压的发生率相似。

结论

当病例量较大的医生提供院前麻醉后，死亡率似乎较低。