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Front. Neurol. | doi: 10.3389/fneur.2018.00194

Prehospital intubation and outcome in traumatic brain injury – Assessing intervention efficacy in a modern trauma cohort.

  • 1Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute (KI), Sweden
  • 2Department of Anesthesia and Intensive Care, Södersjukhuset, Sweden
  • 3Department of Physiology and Pharmacology, Section of Anesthesiology and Intensive Care, Karolinska Institute (KI), Sweden
  • 4Department of Clinical Neuroscience, Karolinska Institute (KI), Sweden
  • 5Department of Neurosurgery, Karolinska University Hospital, Sweden
  • 6Department of Clinical Neuroscience, University of Cambridge, United Kingdom

Background: Prehospital intubation in traumatic brain injury (TBI) focuses on limiting the effects of secondary insults such as hypoxia, but no indisputable evidence has been presented that it is beneficial for outcome. The aim of this study was to explore the characteristics of patients that undergo prehospital intubation and, in turn, if these parameters affect outcome.
Material and methods: Patients ≥15 years admitted to the Department of Neurosurgery, Stockholm, Sweden with TBI from 2008 through 2014 were included. Data were extracted from prehospital and hospital charts, including prospectively collected Glasgow Outcome Score (GOS) after 12 months. Univariate and multivariable logistic regression models were employed to examine parameters independently correlated to prehospital intubation and outcome.
Results: A total of 458 patients were included (n=178 unconscious, among them n=61 intubated). Multivariable analyses indicated that high energy trauma, prehospital hypotension, pupil unresponsiveness, mode of transportation and distance to the hospital were independently correlated with intubation, and among them only pupil responsiveness was independently associated with outcome. Prehospital intubation did not add independent information in a step-up model versus GOS (p=0.154). Prehospital reports revealed that hypoxia was not the primary cause of prehospital intubation, and that the procedure did not improve oxygen saturation during transport, while an increasing distance from the hospital increased the intubation frequency.
Conclusion: In this modern trauma cohort, prehospital intubation was not independently associated with outcome, however hypoxia was not a common reason for prehospital intubation. Prospective trials to assess efficacy of prehospital airway intubation will be difficult due to logistical and ethical considerations.

Keywords: Traumatic brain injury (TBI), Advanced airway management, Prehospital emergency care, Emergency Medical Services, Humans

Received: 15 Sep 2017; Accepted: 13 Mar 2018.

Edited by:

Stefania Mondello, Università degli Studi di Messina, Italy

Reviewed by:

Karim A. Sarhane, University of Toledo, United States
Lai Yee Leung, Walter Reed Army Institute of Research, United States  

Copyright: © 2018 Rubenson Wahlin, Nelson, Bellander, Svensson, Helmy and Thelin. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Eric P. Thelin, Karolinska Institute (KI), Department of Clinical Neuroscience, Solna, Sweden,