The Effect of Paramedic Rapid Sequence Intubation on Outcome in Patients with Severe Traumatic Brain Injury

Abstract

Paramedic RSI protocols to facilitate intubation of head-injured patients were associated with an increase in mortality and decrease in good outcomes versus matched historical controls.

Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence

“…In five studies, 30 32 -35 the frequency of different procedure failures or complications during airway management were reported. With pre-hospital intubation, intubation failure or complication rates ranged from 2.1% 30 to 41.1% 35 (Table 4). Two reports 30 34 included absolute numbers of intubation failures in the pre-hospital and in-hospital period; study results were inconclusive (Fig.…”

“…5). Three studies 7 30 36 reported on pneumonia after pre-hospital or in-hospital intubation; it was the primary study outcome in In-hospital mortality Suominen and colleagues 29 Sloane and colleagues 30 Winchell and colleagues 31 Gausche and colleagues 32 Murray and colleagues 33 Cooper and colleagues 34 Davis and colleagues 35 Bochicchio and colleagues 36 DiRusso and colleagues 37 Wang and colleagues 38 Davis and colleagues 39 Davis and colleagues 28 Klemen and Grmec 40 1 h mortality von Elm et al …”

“…Five studies 32 35 36 40 41 reported on measured respiratory parameters: three 36 40 41 on oxygen saturation at baseline or time of hospital admission or both; one 32 on median oxygen saturation; and one 35 on arterial blood gases measured at hospital admission. Hyperventilation was described in two studies: 6% of intubated patients were hyperventilated in one study 41 and all patients with signs of clinical deterioration in another.…”

“…7 Pre-hospital intubation and mechanical ventilation In four articles, 32 35 36 40 pre-hospital intubation and ventilation protocols were described in detail. In two studies, paramedics received specific training within the study's framework for 6 32 and 8 h, 35 respectively. RSI was performed in all field-intubated patients in four studies 30 35 36 40 and partly in three studies.…”

“…31 Assessment of study quality Study design and classification of evidence There were 12 retrospective analyses of trauma databases, registries, or hospital files, 7 28 -31 33 34 37 -39 41 42 three cohort studies, 36 40 43 one case -control study, 35 and one controlled trial with treatment allocation by alternating date 32 (Table 1). Of the database studies, eight 28 40 43 and the case -control study 35 had a historical control group. Using the Brain Trauma Foundation classification, we regarded 14 included studies 7 28 -31 33 34 36 -39 41 -43 as class 3 evidence and three studies as class 2 evidence (Table 1).…”