Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis. Issue 1 (13th December 2013)

• Record Type: Journal Article
• Authors: Karamanos, Efstathios; Talving, Peep; Skiada, Dimitra; Osby, Melanie; Inaba, Kenji; Lam, Lydia; Albuz, Ozgur; Demetriades, Demetrios
• Is Part Of: Prehospital and disaster medicine. Volume 29:Issue 1(2014)
• Page Start: 32
• Page End: 36
• Publication Date: 2013-12-13
• Subjects: blood gas, -- endotracheal intubation, -- head injury, -- isolated, -- prehospital; Emergency medical services -- Periodicals; Emergency medicine -- Periodicals; Disaster medicine -- Periodicals; 616.025
• DOI: 10.1017/S1049023X13008947
• Languages: English
• ISSNs: 1049-023X

Abstract

Abstract: Introduction: Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant. Hypothesis: Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied. Methods: This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS). Results: Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS. Conclusion: In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted. E Karamanos, P Talving, D Skiada, M Osby, K Inaba, L Lam, O Albuz, D Demetriades .Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis .Prehosp Disaster Med .2013 ;28 (6 ):1 -5 .