A1 Refereed original research article in a scientific journal
A standard operating procedure for prehospital anaesthesia and its effect on mortality : An observational study
Authors: Ljungqvist, Harry; Pirneskoski, Jussi; Saviluoto, Anssi; Iirola, Timo; Kirves, Hetti; Nurmi, Jouni
Publisher: Wiley-Blackwell
Publication year: 2024
Journal: Acta Anaesthesiologica Scandinavica
Journal name in source: ACTA ANAESTHESIOLOGICA SCANDINAVICA
Volume: 68
Issue: 8
First page : 1068
Last page: 1075
ISSN: 0001-5172
eISSN: 1399-6576
DOI: https://doi.org/10.1111/aas.14459(external)
Web address : https://onlinelibrary.wiley.com/doi/10.1111/aas.14459(external)
Self-archived copy’s web address: https://research.utu.fi/converis/portal/detail/Publication/454773194(external)
Background: Prehospital anaesthesia is a complex intervention performed for critically ill patients. To minimise complications, a standard operating procedure (SOP) outlining the process is considered valuable. We investigated the implementation of an SOP for prehospital anaesthesia in helicopter emergency medical services (HEMS).
Methods: We performed a retrospective observational study of patients receiving prehospital anaesthesia by Finnish HEMS from January 2012 to August 2019. The intervention studied was the implementation of an SOP at two of the five bases during 2015-2016. Patients were stratified according to whether they were anaesthetised before, during or after implementation and the primary outcomes were 1- and 30-day mortality. Secondary outcomes included anaesthesia quality indicators. Confounding factors was assessed via logistic regression.
Results: A total of 3902 tracheal intubations were performed without an SOP, 430 during implementation and 1525 after implementation. The SOP had a significant effect on 1-day mortality during implementation with an odds ratio (OR) of 0.56, 95% confidence interval (95% CI) 0.37-0.81 and a further trend towards benefit after implementation (OR 0.84, 95% CI 0.68-1.04), but no difference in 30-day mortality (OR after implementation 1.10, 95% CI 0.92-1.30). Implementation of an SOP improved first-pass success rate from 87.3% to 96.5%, p < 0.001.
Conclusion: Implementation of an SOP for prehospital anaesthesia was associated with a trend towards lower 1-day mortality and an improved first-pass success but did not affect 30-day mortality. Despite this, we advocate prehospital systems to consider implementation of a prehospital anaesthesia SOP as immediate performance markers improved significantly.
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Funding information in the publication:
This work was supported by Helsinki University Hospital (state funding VTR TYH2021224 and TYH2022320). HL received a grant from the Medical Society of Finland while working on this study, however they had no authority in any part of the study design, project management, data collection, data analysis or interpretation, writing of the manuscript or publication. Open Research Supporting Information REFERENCES Early View Online Version of Record before inclusion in an issue Figures References Related Information Recommended Frequency, indications and success of out‐of‐hospital intubations in Finnish children Lauri Elonheimo, Harry Ljungqvist, Heini Harve-Rytsälä, Helena Jäntti, Jouni Nurmi Acta Anaesthesiologica Scandinavica Occupational Illness and Injury in Prehospital Care Personnel Derek L. Isenberg MD, NREMT-P, Carin M. Van Gelder MD Occupational Emergency Medicine, [1] Potential organ donors during two years at the second largest hospital in Norway Gunhild Holmaas, Edle Hilton, Stein Foss, Gaute K. Wathle, Reidar Kvåle Acta Anaesthesiologica Scandinavica Reasons behind failed prehospital intubation attempts while combining C‐MAC videolaryngoscope and Frova introducer Harry E. Ljungqvist, Jouni O. Nurmi
