Schockraummanagement beim Schwer- und Schwerstverletzten

Hussmann, Bjoern; Waydhas, Christian; Lendemans, Sven

doi:10.1007/s00063-012-0093-2

Cited by 7 publications

(1 citation statement)

References 31 publications

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“…It represents an important skill in emergency medical service (EMS) and is recognized as a quality indicator 4. Due to potential risk of severe complications which includes multiple intubation attempts, inadvertent esophageal or bronchial intubation, transient hypoxia, airway edema and bleeding, and tracheal aspiration, out-of-hospital ETI is discussed controversially 5 6. The aim of our study was to determine the prevalence and outcomes of patients who experienced tube malpositioning after emergency out-of-hospital ETI due to severe injuries.…”

Section: Introductionmentioning

confidence: 99%

Physician-based on-scene airway management in severely injured patients and in-hospital consequences: is the misplaced intubation an underestimated danger in trauma management?

Özkurtul

Struck

Fakler

et al. 2019

Trauma Surg Acute Care Open

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BackgroundEndotracheal 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.MethodsIn 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.ResultsOut 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.DiscussionIn 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 evidenceLevel of Evidence IIA.

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Section: Introductionmentioning

confidence: 99%