The Impact of Prehospital Endotracheal Intubation on Outcome in Moderate to Severe Traumatic Brain Injury

Davis, Daniel P.; Peay, Jeremy; Sise, Michael J.; Vilke, Gary M.; Kennedy, Frank; Eastman, A. Brent; Velky, Thomas; Hoyt, David B.

doi:10.1097/01.ta.0000162731.53812.58

Cited by 207 publications

(122 citation statements)

References 43 publications

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“…[5][6][7][8][9] EADs are the most common alternative to intubation in the field and likely the most common rescue airway device for failed intubation, other than bag-mask ventilation. The placement of an EAD can occur quickly, provides a means to oxygenate and ventilate a patient, and in many systems falls within the scope of practice for If the EAD does decrease cerebral perfusion-particularly in patients in a low-flow state-then many of these benefits of EAD placement may be outweighed by increased morbidity and mortality, although this has not been definitively demonstrated by research to date.…”

Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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Objectives: Extraglottic airway devices (EADs) are now commonly placed for airway management of critically ill or injured patients, particularly by emergency medical services providers in the out-ofhospital setting. Recent literature has suggested that EADs may cause decreased cerebral blood flow due to compression of the arteries of the neck by the devices' inflated cuffs. Methods:The authors identified a cohort of 17 patients presumed to be hemodynamically stable with EADs in place who underwent radiographic imaging of the neck. These studies were reviewed by a neuroradiologist to determine if mechanical compression of the carotid arteries was present.Results: None of the 17 cases reviewed had radiographically evident mechanical compression of the carotid artery. Conclusions:Until further studies are performed in which cerebral perfusion is evaluated prospectively in both hemodynamically stable and unstable human subjects, there is insufficicent evidence to recommend against the use of extraglottic airways in the emergency setting on the basis of carotid artery compression.ACADEMIC EMERGENCY MEDICINE 2015;22:636-638 © 2015 by the Society for Academic Emergency Medicine E xtraglottic airway devices (EADs) are commonly placed by emergency medical services (EMS) providers for airway management of critically ill or injured patients in the prehospital setting, and less commonly by physicians in the emergency department (ED). 1 Most EADs use an inflatable cuff in the hypopharynx to prevent airflow into the esophagus and to direct airflow into the trachea and lungs (see Figure 1). There exists a theoretical concern that the inflated cuffs on these devices may cause compression of the arteries in the neck that supply the brain. A recent study by Segal et al. 2 found a decrease in cerebral blood flow when EADs were used in a swine model. Colbert et al. 3 demonstrated that the laryngeal mask airway (LMA) cuff had an effect on the carotid bulb cross-sectional area and blood flow. Nandwani et al. 4 noted no sonographically evident displacement or compression of the internal jugular vein and the carotid artery in human subjects when an LMA was placed. In this study, we took advantage of a common practice at our institution in which well-functioning EADs placed in the field are left in situ for initial resuscitation and imaging in the ED. As a result, we have a number of patients who have undergone cross-sectional computed tomography (CT) studies of the cervical spine with various EADs in place. We examined whether or not mechanical carotid artery compression presumed to be secondary to the presence of the air-filled cuff in the hypopharynx was present in patients who underwent neck imaging studies and had EADs in place. We hypothesized that carotid artery compression would not be identified. METHODS Study DesignThis was a retrospective study of images acquired during usual care in our ED. This study received an exemption from our institutional review board.

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Section: Discussionmentioning

confidence: 99%

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

White¹,

Braude²,

Lorenzo

et al. 2015

Academic Emergency Medicine

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“…One study adjusted for GCS, 40 another 29 did not. Adjustment for GCS was unclear in one study 28 and was not reported for the TBI subgroup in another. 7 In 10 studies with groupspecific information on the severity of TBI, the mean or median AIS of head region ranged from 3.2 7 to 5.1 29 in the intubation groups, and from 2.7 7 to 5.0 31 in the control groups.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…In three of these studies, 7 28 29 the difference between the groups was 5 ISS points or more. Adjustment for ISS was not done in one study, 29 unclear in another, 28 and not reported for the subgroup of headinjured patients in yet another study. 7 Pre-hospital intubation and mechanical ventilation In four articles, 32 35 36 40 pre-hospital intubation and ventilation protocols were described in detail.…”

Section: Patient Characteristicsmentioning

confidence: 99%

“…23 -26 Two reports 19 27 were excluded because they used the same registry data as one of the included studies. 28 We eventually included 17 articles published between 1997 and 2007 7 28-43 reporting on patient data collected between 1985 and 2004. Thirteen studies were conducted in the USA, and four in Europe (Table 1). Of the US studies, seven were from California, and of those five from San Diego County (with overlapping periods of data collection).…”

Section: Included Studiesmentioning

confidence: 99%

“…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).…”

Section: Included Studiesmentioning

confidence: 99%

See 2 more Smart Citations

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

Elm

Schoettker

Henzi

et al. 2009

British Journal of Anaesthesia

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Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury

et al. 2019

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IMPORTANCE Traumatic brain injury (TBI) is a massive public health problem. While evidence-based guidelines directing the prehospital treatment of TBI have been promulgated, to our knowledge, no studies have assessed their association with survival. OBJECTIVE To evaluate the association of implementing the nationally vetted, evidence-based, prehospital treatment guidelines with outcomes in moderate, severe, and critical TBI. DESIGN, SETTING, AND PARTICIPANTS The Excellence in Prehospital Injury Care (EPIC) Study included more than 130 emergency medical services systems/agencies throughout Arizona. This was a statewide, multisystem, intention-to-treat study using a before/after controlled design with patients with moderate to critically severe TBI (US Centers for Disease Control and Prevention Barell Matrix-Type 1 and/or Abbreviated Injury Scale Head region severity Ն3) transported to trauma centers between

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The Impact of Prehospital Endotracheal Intubation on Outcome in Moderate to Severe Traumatic Brain Injury

Abstract: Prehospital intubation is associated with a decrease in survival among patients with moderate-to-severe TBI. More critically injured patients may benefit from prehospital intubation but may be difficult to identify prospectively.

Cited by 207 publications

References 43 publications

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

Radiographic Evaluation of Carotid Artery Compression in Patients With Extraglottic Airway Devices in Place

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

Association of Statewide Implementation of the Prehospital Traumatic Brain Injury Treatment Guidelines With Patient Survival Following Traumatic Brain Injury

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