院前急诊颈前通路(FONA)的成功率：一项系统回顾和meta分析

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院前急诊颈前通路(FONA)的成功率：一项系统回顾和meta分析

贵州医科大学

麻醉与心脏电生理课题组

翻译 :  佟睿 

编辑 :  严旭  

审校 :  曹莹

背景：颈前通路(FONA)是在院前环境中作为实现呼吸道通畅的一种紧急的最后手段。在这项结合Meta分析的系统回顾中，我们旨在评估FONA在院前环境中的数量和成功率。同时也包括自2017年以来的变化，当时这种外科技术被概述为院前一线方法。

方法：我们进行了从数据库建立到2022年7月系统地文献搜索(PROSPERO CRD42022348975)，纳入了全年龄接受院前FONA患者的研究，然后进行了数据提取。Meta分析用于计算汇集成功率。纳入研究的方法学质量使用Cochrane偏差风险工具进行解释，并使用推荐评估、发展和评估分级(GRADE)方法进行评级。

结果：在检索到的909项研究中，纳入了69项报道了3292例院前FONA患者(1229项可供分析)的研究(33项低质量；36项极低质量)。粗成功率中位数由2017年前的99.2%升至2017年后的100%。Meta分析显示FONA的总体成功率为88.0%(95%可信区间[CI]，85.0%-91.0%)。气管切开手术的成功率最高，中位数为100.0%(汇集成功率为92.0%；95%可信区间为88.0%-95.0%)，而环甲膜穿刺组成功率为50.0%(汇集成功率为52.0%；95%可信区间为28.0%-76.0%)。

结论：尽管在院前环境中，FONA是一种相对罕见的手术，但FONA的成功率很高。FONA的气管切开技术似乎比环甲膜穿刺技术更成功，并支持现有的英国院前指南。

原始文献来源 ：  

Sarah Morton, Pascale Avery, Justin Kua, et al. Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis. [J]Br J Anae, doi: 10.1016/j.bja.2023.01.022. 

英文原文

Success rate of prehospital emergency front-of-neck access (FONA): a systematic review and meta-analysis

Abstract

Background: Front-of-neck access (FONA) is an emergency procedure used as a last resort to achieve a patent airway in the prehospital environment. In this systematic review with meta-analysis, we aimed to evaluate the number and success rate of FONA procedures in the prehospital setting, including changes since 2017, when a surgical technique was outlined as the first-line prehospital method.

Method: A systematic literature search (PROSPERO CRD42022348975) was performed from inception of databases to July 2022 to identify studies in patients of any age undergoing prehospital FONA, followed by data extraction. Meta-analysis was used to derive pooled success rates. Methodological quality of included studies was interpreted using the Cochrane risk of bias tool, and rated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Results: From 909 studies, 69 studies were included (33 low quality; 36 very low quality) with 3292 prehospital FONA attempts described (1229 available for analysis). The crude median success rate increased from 99.2% before 2017 to 100.0% after 2017. Meta-analysis revealed a pooled overall FONA success rate of 88.0% (95% confidence interval [CI], 85.0-91.0%). Surgical techniques had the highest success rate at a median of 100.0% (pooled rate=92.0%; 95% CI, 88.0-95.0%) vs 50.0% for needle techniques (pooled rate=52.0%; 95% CI, 28.0-76.0%).

Conclusion: Despite being a relatively rare procedure in the prehospital setting, the success rate for FONA is high. A surgical technique for FONA appears more successful than needle techniques, and supports existing UK prehospital guidelines.

免责声明：

文中所涉及药物使用、疾病诊疗等内容仅供医学专业人士参考。

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编辑：Michel.米萱

校对：MiLu.米鹭