Physician-based on-scene airway management in severely injured patients and in-hospital consequences: is the misplaced intubation an underestimated danger in trauma management?
esophageal
intubation
misplacement
out-of-hospital
polytrauma
severely injured
Journal
Trauma surgery & acute care open
ISSN: 2397-5776
Titre abrégé: Trauma Surg Acute Care Open
Pays: England
ID NLM: 101698646
Informations de publication
Date de publication:
2019
2019
Historique:
entrez:
23
3
2019
pubmed:
23
3
2019
medline:
23
3
2019
Statut:
epublish
Résumé
Endotracheal intubation (ETI) is the gold standard for the out-of-hospital emergency airway management in severely injured patients. Due to time-critical circumstances, poor patient presentation and hostile environments, it may be prone for mechanical complications and failure. In a retrospective study (January 2011 to December 2013), all patients who underwent out-of-hospital ETI before admittance to a level 1 trauma center were analyzed consecutively. Patients with supraglottic airways, being under cardiopulmonary resuscitation and interfacility transports were excluded. The main study endpoint was the incidence of unrecognized tube malposition; secondary endpoints were Glasgow Outcome Scale (GOS) and in-hospital mortality adjusted to on-scene Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Scale head (AIS head), and on-scene time. Out of 1176 patients, 151 underwent out-of-hospital ETI. At hospital admission, tube malpositions were recognized in nine patients (5.9%). Accidental and unrecognized esophageal intubation was detected in five patients (3.3%) and bronchial intubation in four patients (2.7%). Although ISS (p=0.053), AIS head (p=0.469), on-scene GCS (p=0.151), on-scene time (p=0.530), GOS (p=0.748) and in-hospital mortality (p=0.431) were similar compared with correctly positioned ETI tubes, three esophageal intubation patients died due to hypoxemic complications. In our study sample, out-of-hospital emergency ETI in severely injured patients was associated with a considerable tube misplacement rate. For safety, increased compliance to consequently use available technologies (eg, capnography, video laryngoscopy) for emergency ETI should be warranted. Level of Evidence IIA.
Sections du résumé
BACKGROUND
BACKGROUND
Endotracheal intubation (ETI) is the gold standard for the out-of-hospital emergency airway management in severely injured patients. Due to time-critical circumstances, poor patient presentation and hostile environments, it may be prone for mechanical complications and failure.
METHODS
METHODS
In a retrospective study (January 2011 to December 2013), all patients who underwent out-of-hospital ETI before admittance to a level 1 trauma center were analyzed consecutively. Patients with supraglottic airways, being under cardiopulmonary resuscitation and interfacility transports were excluded. The main study endpoint was the incidence of unrecognized tube malposition; secondary endpoints were Glasgow Outcome Scale (GOS) and in-hospital mortality adjusted to on-scene Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Scale head (AIS head), and on-scene time.
RESULTS
RESULTS
Out of 1176 patients, 151 underwent out-of-hospital ETI. At hospital admission, tube malpositions were recognized in nine patients (5.9%). Accidental and unrecognized esophageal intubation was detected in five patients (3.3%) and bronchial intubation in four patients (2.7%). Although ISS (p=0.053), AIS head (p=0.469), on-scene GCS (p=0.151), on-scene time (p=0.530), GOS (p=0.748) and in-hospital mortality (p=0.431) were similar compared with correctly positioned ETI tubes, three esophageal intubation patients died due to hypoxemic complications.
DISCUSSION
CONCLUSIONS
In our study sample, out-of-hospital emergency ETI in severely injured patients was associated with a considerable tube misplacement rate. For safety, increased compliance to consequently use available technologies (eg, capnography, video laryngoscopy) for emergency ETI should be warranted.
LEVEL OF EVIDENCE
METHODS
Level of Evidence IIA.
Identifiants
pubmed: 30899797
doi: 10.1136/tsaco-2018-000271
pii: tsaco-2018-000271
pmc: PMC6407536
doi:
Types de publication
Journal Article
Langues
eng
Pagination
e000271Déclaration de conflit d'intérêts
Competing interests: None declared.
Références
Ann Emerg Med. 2001 Jan;37(1):32-7
pubmed: 11145768
Resuscitation. 2003 Jul;58(1):49-58
pubmed: 12867309
Acad Emerg Med. 2003 Sep;10(9):961-5
pubmed: 12957980
Anaesthesist. 2004 Jun;53(6):543-50
pubmed: 15088093
Acad Emerg Med. 2004 Jun;11(6):707-9
pubmed: 15175215
Br J Anaesth. 2006 Jan;96(1):67-71
pubmed: 16311285
Anesth Analg. 2007 Mar;104(3):619-23
pubmed: 17312220
Anaesthesist. 2007 Apr;56(4):328-34
pubmed: 17334740
Prehosp Emerg Care. 2007 Apr-Jun;11(2):213-8
pubmed: 17454811
Curr Opin Anaesthesiol. 2008 Apr;21(2):222-7
pubmed: 18443493
Emerg Med J. 2009 Jan;26(1):65-9
pubmed: 19104110
Anesth Analg. 2009 Aug;109(2):489-93
pubmed: 19608824
Anaesthesia. 2009 Sep;64(9):973-7
pubmed: 19686482
Scand J Trauma Resusc Emerg Med. 2010 Jun 14;18:30
pubmed: 20546578
Am J Emerg Med. 2011 Jul;29(6):639-44
pubmed: 20825848
Resuscitation. 2011 Apr;82(4):378-85
pubmed: 21288624
Acta Anaesthesiol Scand. 2012 Feb;56(2):164-71
pubmed: 22060976
Unfallchirurg. 2012 Jan;115(1):14-21
pubmed: 22274599
Med Klin Intensivmed Notfmed. 2012 Apr;107(3):217-27; quiz 228-9
pubmed: 22526063
J Anesth. 2013 Jun;27(3):374-9
pubmed: 23238811
Scand J Trauma Resusc Emerg Med. 2013 Jul 25;21:58
pubmed: 23883447
Emerg Med J. 2015 Apr;32(4):291-4
pubmed: 24154942
Br J Anaesth. 2014 Aug;113(2):220-5
pubmed: 25038154
Br J Anaesth. 2015 Apr;114(4):657-62
pubmed: 25540067
Eur J Trauma Emerg Surg. 2017 Aug;43(4):481-489
pubmed: 27072108
Anaesthesist. 2017 Mar;66(3):195-206
pubmed: 28138737