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Association between case volume and mortality in pre-hospital anaesthesia management: a retrospective observational cohort

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 mort...

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Detalles Bibliográficos
Autores principales: Saviluoto, Anssi, Jäntti, Helena, Kirves, Hetti, Setälä, Piritta, Nurmi, Jouni O.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8792835/
https://www.ncbi.nlm.nih.gov/pubmed/34656323
http://dx.doi.org/10.1016/j.bja.2021.08.029
Descripción
Sumario: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.