The impact of prehospital endotracheal intubation on mortality in traumatic brain injury

Our study aimed to evaluate whether prehospital endotracheal intubation (ETI) affects the mortality of individuals who sustain traumatic brain injury (TBI) compared with bag-valve mask (BVM) ventilation, as well as to test the interaction effect of ETI on study outcome according to carbon dioxide le...

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Bibliographic Details
Published in:The American journal of emergency medicine 2022-05, Vol.55, p.152-156
Main Authors: Jung, Eujene, Cho, Yong soo, Ryu, Seok jin, Kim, Dong ki, Lee, Ji ho, Han, Jun ho
Format: Article
Language:English
Subjects:
Airway management
Brain Injuries, Traumatic - therapy
Carbon Dioxide
Clinical outcomes
Demographics
Emergency medical care
Emergency medical services
Emergency Medical Services - methods
Endotracheal intubation
Fires
Hospitals
Humans
Hypercarbia
Hypocarbia
Hypoxia
Intubation
Intubation, Intratracheal - methods
Mortality
Patients
Recovery of function
Regression analysis
Respiratory tract
Retrospective Studies
Skills
Survival
Technicians
Trauma
Trauma centers
Traumatic brain injury
Variables
Ventilation
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Summary:Our study aimed to evaluate whether prehospital endotracheal intubation (ETI) affects the mortality of individuals who sustain traumatic brain injury (TBI) compared with bag-valve mask (BVM) ventilation, as well as to test the interaction effect of ETI on study outcome according to carbon dioxide level. Our retrospective study involving patients who experienced TBI between January 2019 and December 2020. The main exposure variable was the prehospital airway management technique (ETI vs. BVM) performed by emergency medical service technicians and the primary outcome was survival at hospital discharge and the secondary outcome was good functional recovery at hospital discharge and six-month survival. We performed multivariable logistic regression analysis and interaction analysis between the prehospital airway management and blood level of carbon dioxide for adjusted odds ratios (aORs) and 95% confidence intervals (CIs). Of 562 eligible patients, 79 (14.1%) underwent ETI and 483 (85.9%) underwent BVM ventilation. After adjusting for possible confounders, TBI patients in the ETI group has a significantly lower likehood of survival to discharge than those in the BVM group (aOR 0.57 (0.41–0.73). In interaction analysis, the rates of survival to discharge and 6-month survival with ETI were significantly lower only in groups with hypocarbia (AOR 0.61 [95% CI 0.49–0.72] and AOR 0.82 [95% CI 0.65–0.99], respectively). Among individuals who experienced severe TBI, prehospital intubation did not have a significant effect on survival outcomes and good functional recovery. Patients exhibiting hypocarbia measured on hospital arrival demonstrated lower survival outcomes in the interaction analysis.
ISSN:0735-6757
1532-8171
DOI:10.1016/j.ajem.2022.02.001