Prehospital intubations and mortality: A level 1 trauma center perspective

Miguel Cobas, Maria Alejandra De La Peña, Ronald Manning, Keith A Candiotti, Albert J. Varon

Research output: Contribution to journalArticle

116 Citations (Scopus)

Abstract

BACKGROUND: Ryder Trauma Center is a Level 1 trauma center with approximately 3800 emergency admissions per year. In this study, we sought to determine the incidence of failed prehospital intubations (PHI), its correlation with hospital mortality, and possible risk factors associated with PHI. METHODS: A prospective observational study was conducted evaluating trauma patients who had emergency prehospital airway management and were admitted during the period between August 2003 and June 2006. The PHI was considered a failure if the initial assessment determined improper placement of the endotracheal tube or if alternative airway management devices were used as a rescue measure after intubation was attempted. RESULTS: One-thousand-three- hundred-twenty patients had emergency airway interventions performed by an anesthesiologist upon arrival at the trauma center. Of those, 203 had been initially intubated in the field by emergency medical services personnel, with 74 of 203 (36%) surviving to discharge. When evaluating the success of the intubation, 63 of 203 (31%) met the criteria for failed PHI, all of them requiring intubation, with only 18 of 63 (29%) surviving to discharge. These patients had rescue airway management provided either via Combitube® (n = 28), Laryngeal Mask Airway® (n = 6), or a cricothyroidotomy (n = 4). An additional 25 of 63 patients (12%) had unrecognized esophageal intubations discovered upon the initial airway assessment performed on arrival. We found no difference in mortality between those patients who were properly intubated and those who were not. Several other variables, including age, gender, weight, mechanism of injury, presence of facial injuries, and emergency medical services were not correlated with an increased incidence of failed intubations. CONCLUSION: This prospective study showed a 31% incidence of failed PHI in a large metropolitan trauma center. We found no difference in mortality between patients who were properly intubated and those who were not, supporting the use of bag-valve-mask as an adequate method of airway management for critically ill trauma patients in whom intubation cannot be achieved promptly in the prehospital setting.

Original languageEnglish
Pages (from-to)489-493
Number of pages5
JournalAnesthesia and Analgesia
Volume109
Issue number2
DOIs
StatePublished - Aug 1 2009

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Trauma Centers
Intubation
Mortality
Airway Management
Emergencies
Emergency Medical Services
Incidence
Wounds and Injuries
Prospective Studies
Facial Injuries
Laryngeal Masks
Masks
Hospital Mortality
Critical Illness
Observational Studies
Weights and Measures
Equipment and Supplies

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Prehospital intubations and mortality : A level 1 trauma center perspective. / Cobas, Miguel; De La Peña, Maria Alejandra; Manning, Ronald; Candiotti, Keith A; Varon, Albert J.

In: Anesthesia and Analgesia, Vol. 109, No. 2, 01.08.2009, p. 489-493.

Research output: Contribution to journalArticle

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abstract = "BACKGROUND: Ryder Trauma Center is a Level 1 trauma center with approximately 3800 emergency admissions per year. In this study, we sought to determine the incidence of failed prehospital intubations (PHI), its correlation with hospital mortality, and possible risk factors associated with PHI. METHODS: A prospective observational study was conducted evaluating trauma patients who had emergency prehospital airway management and were admitted during the period between August 2003 and June 2006. The PHI was considered a failure if the initial assessment determined improper placement of the endotracheal tube or if alternative airway management devices were used as a rescue measure after intubation was attempted. RESULTS: One-thousand-three- hundred-twenty patients had emergency airway interventions performed by an anesthesiologist upon arrival at the trauma center. Of those, 203 had been initially intubated in the field by emergency medical services personnel, with 74 of 203 (36{\%}) surviving to discharge. When evaluating the success of the intubation, 63 of 203 (31{\%}) met the criteria for failed PHI, all of them requiring intubation, with only 18 of 63 (29{\%}) surviving to discharge. These patients had rescue airway management provided either via Combitube{\circledR} (n = 28), Laryngeal Mask Airway{\circledR} (n = 6), or a cricothyroidotomy (n = 4). An additional 25 of 63 patients (12{\%}) had unrecognized esophageal intubations discovered upon the initial airway assessment performed on arrival. We found no difference in mortality between those patients who were properly intubated and those who were not. Several other variables, including age, gender, weight, mechanism of injury, presence of facial injuries, and emergency medical services were not correlated with an increased incidence of failed intubations. CONCLUSION: This prospective study showed a 31{\%} incidence of failed PHI in a large metropolitan trauma center. We found no difference in mortality between patients who were properly intubated and those who were not, supporting the use of bag-valve-mask as an adequate method of airway management for critically ill trauma patients in whom intubation cannot be achieved promptly in the prehospital setting.",
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