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Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis

Published online by Cambridge University Press:  13 December 2013

Efstathios Karamanos ,
Peep Talving ,
Dimitra Skiada ,
Melanie Osby ,
Kenji Inaba ,
Lydia Lam ,
Ozgur Albuz  and
Demetrios Demetriades
Efstathios Karamanos*
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Peep Talving
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Dimitra Skiada
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Melanie Osby
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Kenji Inaba
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Lydia Lam
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Ozgur Albuz
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Demetrios Demetriades
Affiliation:
Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
*
Correspondence: Efstathios Karamanos, MD University of Southern California Keck School of Medicine Department of Surgery LAC+USC Medical Center Division of Acute Care Surgery 1200 North State Street, Room 6341 Los Angeles, CA 90033 USA E-mail [email protected]
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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.

KaramanosE , TalvingP , SkiadaD , OsbyM , InabaK , LamL , AlbuzO , DemetriadesD . 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.

Keywords

blood gasendotracheal intubationhead injuryisolatedprehospital
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 29 , Issue 1 , February 2014 , pp. 32 - 36
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2013 

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