Endotracheal Intubation in the Field Does Not Improve Outcome in Trauma Patients Who Present without an Acutely Lethal Traumatic Brain Injury

TLDR

Prospective data on the effect of prehospital intubation in adult trauma patients are lacking. The authors sought to compare outcomes of field versus hospital arrival intubation in trauma patients without an acutely lethal TBI and to recommend a randomized prospective study. A prospective cohort of 191 adult trauma patients with moderate TBI (field GCS ≤ 8, head AIS ≥ 3) was assembled, comparing 78 field‑intubated to 113 hospital‑intubated patients with similar baseline characteristics. Field intubation was linked to higher morbidity (longer ventilator, ICU, and hospital stays), nearly double mortality (23 % vs.

Abstract

There is an absence of prospective data evaluating the impact of prehospital intubation in adult trauma patients. Our objectives were to determine the outcome of trauma patients intubated in the field who did not have an acutely lethal traumatic brain injury (death within 48 hours) compared with patients who were intubated immediately on arrival to the hospital.Prospective data were collected on 191 consecutive patients admitted to the trauma center with a field Glasgow Coma Scale score < or = 8 and a head Abbreviated Injury Scale score > or = 3 who were either intubated in the field or intubated immediately at admission to the hospital. Patients who died within 48 hours of admission and transfers were excluded from the study.Of the 191 patients, 176 (92%) sustained blunt trauma and 25 (8%) were victims of penetrating trauma. Seventy-eight (41%) of the 191 patients were intubated in the field and 113 (59%) were intubated immediately at admission. There was no significant difference in age, Glasgow Coma Scale score, head Abbreviated Injury Scale score, or Injury Severity Score between the two groups. Patients who were intubated in the field had a significantly higher morbidity (ventilator days, 14.7 vs. 10.4; hospital days, 20.2 vs. 16.7; and intensive care unit days, 15.2 vs. 11.7) compared with patients intubated on immediate arrival to the hospital and nearly double the mortality (23% vs. 12.4). Field-intubated patients had a 1.5 times greater risk of nosocomial pneumonia compared with hospital-intubated patients.Prehospital intubation is associated with a significant increase in morbidity and mortality in trauma patients with traumatic brain injury who are admitted to the hospital without an acutely lethal injury. A randomized, prospective study is warranted to confirm these results.