INTRODUCTION:Cardiovascular deterioration is a recognized complication of emergency intubation. Postintubation hypotension (PIH) has not been investigated in acute trauma resuscitation. We aim to identify the incidence, risk factors, and outcomes associated with PIH in emergency trauma resuscitation. METHODS:Retrospective cohort study of emergency intubations performed from 2020 through October 2021 at Carolinas Medical Center. Data were extracted via the trauma database and manual chart review using a single reviewer and standard data collection instrument. Enrolled patients were 18 year or older, involved in trauma, and intubated in the Emergency Department. Patients with hypotension defined by systolic blood pressure < 90 mmHg, use of vasopressors, or cardiac arrest prior to intubation were excluded. PIH was defined as SBP less than 90 mmHg within 30 minutes if intubation. Patients with PIH were compared to those who did not experience PIH. RESULTS:We identified 540 patients in our trauma database; 294 patients met criteria for the study. The mean patient age was 43 years old and 77.6% of patients were male. PIH occurred in 36 of 294 (12.2%) patients. Patients experiencing PIH did not have statistically higher mortality; 22.2% versus 15.9% (difference of 6.3%; 95% CI:-0.19 to 0.07; p = 0.34), but they did experience longer ICU length of stay: 8 versus 5.6 days (difference of 2.4 days; 95% CI: -4.23 to -0.46; p = 0.015) and longer hospital length of stay: 25.4 versus 12.3 days (difference of 13.1 days; 95% CI: -23.58 to -2.67; p = 0.01). PIH patients had higher pre-intubation shock index (0.8 versus 0.69, p < 0.01), had lower pre-intubation systolic blood pressure (133 mmHg versus 144 mmHg, p = 0.036), experienced higher number of intubation attempts (1.26 versus 1.07, p < 0.01), and were more likely to be female (0.56 versus 0.18, p = < 0.01). We invested comorbidities and medications associated with PIH and found that PIH patients had higher exposure to angiotensin converting enzyme (ACE) inhibitors at 17% compared to 3%; p < 0.01. CONCLUSIONS:PIH is a common complication of emergency intubation in trauma patients and is associated with higher complexity of illness as identified by ICU and hospital length of stay. We identified several clinical risk factors associated with PIH in trauma patients.