Читать книгу Emergency Medical Services - Группа авторов - Страница 65

Several studies draw attention to previously unrecognized adverse events associated with prehospital ETI. Successful prehospital airway management strategies have placed strong emphasis on minimizing these and other adverse events. Many of these adverse events have been detected only through enhanced monitoring technology and rigorous airway management review.

Several studies describe complications of prehospital airway management including misplaced or dislodged endotracheal tubes [14–17]. Using continuous EtCO₂ has reduced the incidence of the unrecognized misplaced endotracheal tube. Prehospital ETI may distract from other important resuscitation tasks. For example, hyperventilation after successful ETI of cardiac arrest patients can compromise coronary perfusion during CPR chest compressions [18, 19]. Furthermore, conventional ETI efforts may increase CPR “hands‐off” or no‐flow time (pauses in CPR to facilitate endotracheal intubation) compared with other airway devices [20]. Models of high‐performance CPR now teach rescuers to defer airway management in favor of providing uninterupted compressions.

Prehospital intubation has been associated with increased exposure to hypoxia, hypotension, and hypocapnia [21, 22]. Iatrogenic oxygen desaturation or braydcardia is common during intubation attempts [23]. Advanced age, preprocedural hypotension, and hypoxia are associated with peri‐intubation hypotension [24]. Hypoxia and bradycardia may be prevented by continuous monitoring of pulse oxymetry and provision of oxygen during apneia or supplemental ventilation [25, 26]. Postprocedure hypocapnia may be mitigated by flow‐limiting bag ventilation, timing devices for respiration, or mechanical ventilation. EMS medical directors should anticipate these events and promulgate protocols that direct resuscitation prior to intubation and limit exposure to hypotension, hypoxia, and hypocarbia through continuous monitoring and appropriate intervention.