Prehospital Intubation is Associated with Higher Mortality in Patients
Requiring Massive Transfusions
Alban, Rodrigo, MD, FACS, Corsa, Joshua G, MD, NREMT-P, Promes,
Jonathan, MD, FACS
Introduction
Prehospital Intubation has been a critical part of a Paramedic’s
armamentarium for nearly three decades. Despite that, few studies have
been conducted to evaluate the efficacy and mortality of trauma patients
intubated in the field. Studies conducted on swine and rat models have both
failed to demonstrate a survival advantage with early intubation. We
proposed to examine trauma outcomes in patients who required massive
transfusion both with and without intubation.
Methods
Using a retrospective chart review, 193 patients requiring twelve or more
units of blood products between 2009 and 2013 were analyzed. Patient
demographics, length of stay, injury severity scores, and scene times were
obtained through our trauma database and EMS reports. A Mann-Whitney U
test was used to compare continuous variables. A p-value of 0.05 was
considered statistically significant. Logical Regression was used to evaluate
for the changes in ISS.
Results
Of the 193 patients, 72 sustained penetrating trauma, and 121 sustained
blunt trauma. 21 underwent prehospital intubation. Prehospital intubation
was a statistically significant indicator of increased mortality, ventilator
days, hospital days, and scene times.
Conclusions
Prehospital intubation is associated with an increased risk of mortality, even
when adjusting for increased ISS. This is in line with both small and large
animal models that did not demonstrate a survival advantage with
intubation. While statistically significant, it is unknown if increased scene
time is the major reason for the increased mortality, or if physiologic factors
such as increased intrathoracic pressure and hyperventilation are significant
factors. The animal models cited suggest the later. More research will be
needed to compare esophageal obturator airways against bag valve mask
ventilation to see if either of these interventions confers a survival
advantage.