Preliminary Report: Comparing Aspiration Rates between Prehospital Patients Managed with Extraglottic Airway Devices and Endotracheal Intubation

Steuerwald, Michael; Braude, Darren; Petersen, Timothy R.; Peterson, Kari; Torres, Michael A.

doi:10.1016/j.amj.2018.04.004

Cited by 12 publications

(22 citation statements)

References 14 publications

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“…Seven studies involved non-traumatic unconscious patients (poisoned or intoxicated patients) [6,8,[16][17][18][19][20], 4 studies enlisted traumatic brain injury (TBI) patients [11,[21][22][23]. A study enrolled adult patients who required intubation for traumatic and non-traumatic cases [24]; a study enrolled pediatric mixed traumatic and non-traumatic cases [12].…”

Section: Resultsmentioning

confidence: 99%

“…All studies were observational: 4 enrolled patients prospectively [8,16,18,21], while the remaining 9 were retrospective [6,11,12,17,19,20,[22][23][24]. Only one study, among those prospective, specified the consecutive enrollment of patients [8].…”

Section: Resultsmentioning

confidence: 99%

“…Only one study, among those prospective, specified the consecutive enrollment of patients [8]. Five studies were conducted in an Emergency Department (ED) [8,16,17,19,20], 7 related to the pre-hospital environment [6,11,12,[21][22][23][24], and one study was conducted both in the prehospital setting and in the ED. [18] The sample size ranged from 26 to 21,242 patients.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies did not specify this criterion, or enrolled any patient with a GCS less than 15 (then classifying them into subgroups). The role of the operator who performed the intubation was, in 7 studies, a physician (in most cases an ED physician) [5,[8][9][10][11][12]17]; in 4 studies, it was an EMS provider (in most cases a paramedic) [11,21,22,24].…”

Section: Resultsmentioning

confidence: 99%

“…The average reliability was moderate or low. Many studies were retrospective, so the risk of bias not precisely assessable [6,11,12,[17][18][19][20][21][22][23][24]. We did not identify any randomized clinical trials.…”

Section: Quality Appraisalmentioning

confidence: 99%

See 4 more Smart Citations

Endotracheal intubation to reduce aspiration events in acutely comatose patients: a systematic review

Orso

Vetrugno

Federici

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background It is customary to believe that a patient with a Glasgow Coma Scale (GCS) score less than or equal to 8 should be intubated to avoid aspiration. We conducted a systematic review to establish if patients with GCS ≤ 8 for trauma or non-traumatic emergencies and treated in the acute care setting (e.g., Emergency Department or Pre-hospital environment) should be intubated to avoid aspiration or aspiration pneumonia/pneumonitis, and consequently, reduce mortality. Methods We searched six databases, Pubmed, Embase, Scopus, SpringerLink, Cochrane Library, and Ovid Emcare, from April 15th to October 14th, 2020, for studies involving low GCS score patients of whom the risk of aspiration and related complications was assessed. Results Thirteen studies were included in the final analysis (7 on non-traumatic population, 4 on trauma population, 1 pediatric and 1 adult mixed case studies). For the non-traumatic cases, two prospective studies and one retrospective study found no difference in aspiration risk between intubated and non-intubated patients. Two retrospective studies reported a reduction in the risk of aspiration in the intubated patient group. For traumatic cases, the study that considered the risk of aspiration did not show any differences between the two groups. A study on adult mixed cases found no difference in the incidence of aspiration among intubated and non-intubated patients. A study on pediatric patients found increased mortality for intubated versus non-intubated non-traumatic patients with a low GCS score. Conclusion Whether intubation results in a reduction in the incidence of aspiration events and whether these are more frequent in patients with low GCS scores are not yet established. The paucity of evidence on this topic makes clinical trials justifiable and necessary. Trial registration Prospero registration number: CRD42020136987.

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