Mechanical complications and outcomes following invasive emergency procedures in severely injured trauma patients

Abstract

This study aimes to determine the complication rates, possible risk factors and outcomes of emergency procedures performed during resuscitation of severely injured patients. The medical records of patients with an injury severity score (ISS) >15 admitted to the University Hospital Leipzig from 2010 to 2015 were reviewed. Within the first 24 hours of treatment, 526 patients had an overall mechanical complication rate of 26.2%. Multivariate analysis revealed out-of-hospital airway management (OR 3.140; 95% CI 1.963–5.023; p < 0.001) and ISS (per ISS point: OR 1.024; 95% CI 1.003–1.045; p = 0.027) as independent predictors of any mechanical complications. Airway management complications (13.2%) and central venous catheter complications (11.4%) were associated with ISS >32.5 (p < 0.001) and ISS >33.5 (p = 0.005), respectively. Chest tube complications (15.8%) were associated with out-of-hospital insertion (p = 0.002) and out-of-hospital tracheal intubation (p = 0.033). Arterial line complications (9.4%) were associated with admission serum lactate >4.95 mmol/L (p = 0.001) and base excess <−4.05 mmol/L (p = 0.008). In multivariate analysis, complications were associated with an increased length of stay in the intensive care unit (p = 0.019) but not with 24 hour mortality (p = 0.930). Increasing injury severity may contribute to higher complexity of the individual emergency treatment and is thus associated with higher mechanical complication rates providing potential for further harm.

Risk factors and outcomes of unrecognised endobronchial intubation in major trauma patients

“…In a previous study, we found that prehospital airway management and ISS were independently associated with mechanical complications. 11 One possible reason for the contradictory result might have been the considerably smaller sample size of ED intubations compared with prehospital intubations. Another possible reason might have been that prehospital emergency response physicians postponed airway management and intubation to the ED in high-risk patients.…”

“…According to previously published data, we hypothesised that unrecognised endobronchial intubation would be associated with avoidable tube thoracostomies and be associated with prehospital intubation rather than ED intubation. 11 …”

“…Of particular interest were differences in tracheal intubation location and associations of TCD with the performance of tube thoracostomies. According to previously published data, we hypothesised that unrecognised endobronchial intubation would be associated with avoidable tube thoracostomies and be associated with prehospital intubation rather than ED intubation 11…”

“…1 2 Severe iatrogenic complications of tracheal intubation are unrecognised oesophageal intubation and endobronchial intubation. [3][4][5][6][7][8][9][10][11] The potential consequences of unrecognised endobronchial intubation are not as catastrophic as those resulting from unrecognised oesophageal intubation. Nevertheless, unrecognised endobronchial intubation and one-lung ventilation cause atelectasis of the unventilated lung with subsequent hypercapnia and hypoxaemia, which may aggravate already impaired gas exchange in emergency patients.…”

“…Intubation success rates vary considerably depending on different emergency medical service systems and training levels of providers 1 2. Severe iatrogenic complications of tracheal intubation are unrecognised oesophageal intubation and endobronchial intubation 3–11. The potential consequences of unrecognised endobronchial intubation are not as catastrophic as those resulting from unrecognised oesophageal intubation.…”