Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-18T23:15:37.289Z Has data issue: false hasContentIssue false
  • English
  • Français

Physician Prehospital Care in Mexico City: Retrospective Analysis of Endotracheal Intubation in Patients with Severe Head Trauma

Published online by Cambridge University Press:  24 January 2020

J. Sebastián Espino-Núñez Open the ORCID record for J. Sebastián Espino-Núñez [Opens in a new window] ,
Mirsha Quinto-Sánchez ,
Anabel C. Carrada-Varela  and
Fernando Román-Morales
J. Sebastián Espino-Núñez*
Affiliation:
Tecnológico de Monterrey, School of Medicine, Mexico City, Mexico Department of Anesthesiology, The American British Cowdray Medical Centre IAP, Mexico City, Mexico
Mirsha Quinto-Sánchez
Affiliation:
Forensic Science, Faculty of Medicine, Universidad Nacional Autónoma de México, Mexico City, Mexico
Anabel C. Carrada-Varela
Affiliation:
Tecnológico de Monterrey, School of Medicine, Mexico City, Mexico
Fernando Román-Morales
Affiliation:
Mexico City’s Health Secretariat, Emergency Medical Regulation Center, Mexico City, Mexico
*
Correspondence: Juan Sebastián Espino-Núñez, EMT, MD Tecnológico de Monterrey Campus Ciudad de México Calle del Puente 222, Ejidos de Huipulco, 14380TlalpanCDMX, Mexico E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

In Mexico, physicians have become part of public service prehospital care. Head injured patients are a sensitive group that can benefit from early advanced measures to protect the airway, with the objective to reduce hypoxia and maintain normocapnia.

Problem:

The occurrence of endotracheal intubation to patients with severe head injuries by prehospital physicians working at Mexico City’s Service of Emergency Medical Care (SAMU) is unknown.

Methods:

A retrospective analysis of five-year data (2012-2016) from Mexico City’s Medical Emergencies Regulation Center was performed. Only SAMU ambulance services were analyzed. Adult patients with a prehospital diagnosis of head injury based on mechanism of injury and physical examination with a Glasgow Coma Scale (GCS) <nine were included.

Results:

A total of 293 cases met the inclusion criteria; the mean GCS was five points. Of those, 150 (51.1%) patients were intubated. There was no difference in the occurrence of intubation among the different GCS scales, or if the patient was considered to have isolated head trauma versus polytrauma. Fifteen patients were intubated using sedation and neuromuscular blockage. Four patients were intubated with sedation alone and six patients with neuromuscular blockage alone. One patient was intubated using opioid analgesia, sedation, and neuromuscular blockage.

Conclusions:

Patients with severe head injuries cared by prehospital physicians in Mexico City were intubated 51.1% of the time and were more likely to be intubated without the assistance of anesthetics.

Keywords

brain injurytraumaticdeveloping countriesMexicoprehospital intubationretrospective studies
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 35 , Issue 2 , April 2020 , pp. 128 - 132
Copyright
© World Association for Disaster and Emergency Medicine 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Majdan, M, Plancikova, D, Maas, A, et al. Years of life lost due to traumatic brain injury in Europe: a cross-sectional analysis of 16 countries. PLoS Med. 2017;14(7):e1002331.CrossRefGoogle ScholarPubMed
Roozenbeek, B, Maas, AIR, Menon, DK. Changing patterns in the epidemiology of traumatic brain injury. Nat Rev Neurol. 2013;9(4):231–236.CrossRefGoogle ScholarPubMed
Pfeifer, R, Tarkin, IS, Rocos, B, Pape, H-C. Patterns of mortality and causes of death in polytrauma patients--has anything changed? Injury. 2009;40(9):907–911.CrossRefGoogle Scholar
Mayén Casas, JC, Guerrero Torres, N, Caro Lozano, J, Zúñiga Carrasco, IR. Aspectos clínicos y epidemiológicos del trauma craneo-encefálico en México. Boletín Epidemiol Secr Salud-Mexico. 2008;25:27.Google Scholar
Franschman, G, Peerdeman, SM, Greuters, S, et al. Prehospital endotracheal intubation in patients with severe traumatic brain injury: guidelines versus reality. Resuscitation. 2009;80(10):1147–1151.CrossRefGoogle ScholarPubMed
Ebben, RHA, Vloet, LCM, Verhofstad, MHJ, Meijer, S, Mintjes-de Groot, JAJ, van Achterberg, T. Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review. Scand J Trauma Resusc Emerg Med. 2013;21(1):9.CrossRefGoogle ScholarPubMed
Griesdale, DEG, Örtenwall, V, Norena, M, et al. Adherence to guidelines for management of cerebral perfusion pressure and outcome in patients who have severe traumatic brain injury. J Crit Care. 2015;30(1):111–115.10.1016/j.jcrc.2014.07.026CrossRefGoogle ScholarPubMed
Lee, JC, Rittenhouse, K, Bupp, K, et al. An analysis of Brain Trauma Foundation traumatic brain injury guideline compliance and patient outcome. Injury. 2015;46(5):1–5.CrossRefGoogle ScholarPubMed
Rosenfeld, JV, Maas, AI, Bragge, P, Morganti-Kossmann, MC, Manley, GT, Gruen, RL. Early management of severe traumatic brain injury. Lancet. 2012;380(9847):1088–1098.CrossRefGoogle ScholarPubMed
Dumont, TM, Visioni, AJ, Rughani, AI, Tranmer, BI, Crookes, B. Inappropriate prehospital ventilation in severe traumatic brain injury increases in-hospital mortality. J Neurotrauma. 2010;27(7):1233–1241.CrossRefGoogle ScholarPubMed
van de Glind, I, Berben, S, Zeegers, F, et al. A national research agenda for pre-hospital emergency medical services in the Netherlands: a Delphi-study. Scand J Trauma Resusc Emerg Med. 2016;24(1):2.CrossRefGoogle ScholarPubMed
Cone, DC. Knowledge translation in the Emergency Medical Services: a research agenda for advancing prehospital care. Acad Emerg Med. 2007;14(11):1052–1057.10.1197/j.aem.2007.06.014CrossRefGoogle ScholarPubMed
Davis, DP. The need for standardized data reporting for prehospital airway management. Crit Care. 2011;15(2):133.CrossRefGoogle ScholarPubMed
Lockey, DJ. Research questions in pre-hospital trauma care. PLoS Med. 2017;14(7):e1002345.CrossRefGoogle ScholarPubMed
Fevang, E, Lockey, D, Thompson, J, Lossius, HM. The top five research priorities in physician-provided pre-hospital critical care: a consensus report from a European research collaboration. Scand J Trauma Resusc Emerg Med. 2011;19(1):57.CrossRefGoogle ScholarPubMed
Bernard, SA, Nguyen, V, Cameron, P, et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg. 2010;252(6):959–965.10.1097/SLA.0b013e3181efc15fCrossRefGoogle ScholarPubMed
Denninghoff, KR, Nuño, T, Pauls, Q, et al. Prehospital intubation is associated with favorable outcomes and lower mortality in ProTECT III. Prehospital Emerg Care. 2017;21(5):539–544.10.1080/10903127.2017.1315201CrossRefGoogle ScholarPubMed
Timmermann, A, Russo, SG, Eich, C, et al. The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg. 2007;104(3):619–623.10.1213/01.ane.0000253523.80050.e9CrossRefGoogle ScholarPubMed
Lossius, HM, Sollid, SJM, Rehn, M, Lockey, DJ. Revisiting the value of pre-hospital tracheal intubation: an all-time systematic literature review extracting the Utstein airway core variables. Crit Care. 2011;15(1):R26.CrossRefGoogle ScholarPubMed
Bossers, SM, Schwarte, LA, Loer, SA, Twisk, JWR, Boer, C, Schober, P. Experience in prehospital endotracheal intubation significantly influences mortality of patients with severe traumatic brain injury: a systematic review and meta-analysis. PLoS One. 2015;10(10):1–26.Google ScholarPubMed
Fraga-sastrías, JM, Asensio-lafuente, E, Román-morales, F, Pinet-peralta, LM, Prieto-sagredo, J, Ochmann-räsch, A. Sistemas médicos de emergencia en México. Una perspectiva prehospitalaria. Arch Med Urgencias México. 2010;2(52):25–34.Google Scholar
Pinet, LM. Prehospital emergency care in Mexico City: the opportunities of the healthcare system. Salud Publica Mex. 2005;47(1):64–71.10.1590/S0036-36342005000100010CrossRefGoogle ScholarPubMed
de Silva, MJ, Roberts, I, Perel, P, et al. Patient outcome after traumatic brain injury in high-, middle-, and low-income countries: analysis of data on 8927 patients in 46 countries. Int J Epidemiol. 2009;38(2):452–458.CrossRefGoogle ScholarPubMed
Grote, S, Böcker, W, Mutschler, W, Bouillon, B, Lefering, R. Diagnostic value of the Glasgow Coma Scale for traumatic brain injury in 18,002 patients with severe multiple injuries. J Neurotrauma. 2011;28(April):527–534.CrossRefGoogle ScholarPubMed
Arreola-Risa, C, Mock, CN, Lojero-Wheatly, L, et al. Low-cost improvements in prehospital trauma care in a Latin American city. J Trauma. 2000;48(1):119–124.CrossRefGoogle Scholar
Roudsari, BS, Nathens, AB, Arreola-Risa, C, et al. Emergency Medical Service (EMS) systems in developed and developing countries. Injury. 2007;38(9):1001–1013.CrossRefGoogle ScholarPubMed
Bossers, SM, Schwarte, LA, Loer, SA, Twisk, JWR, Boer, C, Schober, P. Experience in prehospital endotracheal intubation significantly influences mortality of patients with severe traumatic brain injury: a systematic review and meta-analysis. PLoS One. 2015;10(10):1–26.CrossRefGoogle ScholarPubMed
Evans, CCD, Brison, RJ, Howes, D, Stiell, IG, Pickett, W. Prehospital non-drug assisted intubation for adult trauma patients with a Glasgow Coma Score less than 9. Emerg Med J. 2013;30(11):935–941.CrossRefGoogle ScholarPubMed
Fullerton, JN, Roberts, KJ, Wyse, M. Should non-anesthetists perform pre-hospital rapid sequence induction? An observational study. Emerg Med J. 2011;28(5):428–431.10.1136/emj.2009.086645CrossRefGoogle Scholar
Ryynänen, O-P, Iirola, T, Reitala, J, Pälve, H, Malmivaara, A. Is advanced life support better than basic life support in prehospital care? A systematic review. Scand J Trauma Resusc Emerg Med. 2010;18(1):62.10.1186/1757-7241-18-62CrossRefGoogle ScholarPubMed