Post by pbruss on Dec 7, 2014 8:09:12 GMT -5
i think there is less and less of a role for EMS intubation in the field. cardiac arrest EMS protocols of: load and go, continuous high quality chest compressions, non-rebreather mask instead of airway and get to the nearest PCI facility might be the beast way to go from what i have read. some of the same could be said for trauma patients as well. see below and 3 attachments.
Assessing the Impact of Prehospital Intubation on Survival in Out-of-Hospital Cardiac Arrest
January-March 2011, Vol. 15, No. 1 , Pages 44-49 (doi:10.3109/10903127.2010.514090)
Joshua Egly, Don Custodio, Nathan Bishop, Michael Prescott, Victoria Lucia, Raymond E. Jackson, and Robert A. Swor
From the Department of Emergency Medicine (JE, REJ, RAS) and the Department of Outcomes Research (VL), William Beaumont Hospital, Royal Oak, Michigan; the Department of Emergency Medicine (DC), Borgess Medical Center, Kalamazoo, Michigan; the Department of Emergency Medicine (NB), Spectrum Health Medical Center, Grand Rapids, Michigan; and the Department of Emergency Medicine (MP), St. Mary's Medical Center, Livonia, Michigan.
Presented at the American College of Emergency Physicians annual meeting, Chicago, Illinois, October 2007, and at the National Association of EMS Physicians annual meeting, Phoenix, Arizona, January 2008.
Department of Emergency Medicine, William Beaumont Hospital is an affiliate of Wayne State University School of Medicine, Detroit, Michigan.
Abstract
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. Objective. To compare the rates of survival to hospital admission and discharge of nontraumatic out-of-hospital cardiac arrest (OHCA) patients who received successful out-of-hospital endotracheal intubation and those who were not intubated. Methods. We conducted a retrospective analysis from an ongoing database of OHCA patients brought to a large suburban tertiary care emergency department by paramedic services between 1995 and 2006. We dichotomized patients by whether they were successfully endotracheally intubated or not prior to hospital arrival. Utstein style cardiac arrest variables were abstracted for all cases. All survivors to hospital admission were reviewed to exclude those patients in whom intubation was not attempted or unnecessary, such as those who had successful first-shock recovery of spontaneous circulation. We used chi square and logistic regression techniques for analysis, using survival to discharge as the primary outcome and survival to admission as a secondary outcome. Results. There were 1,515 total cases with 33 early survivors excluded. Overall, 1,220 (86.2%%) were intubated; of those intubated, 270 (20.2%%) survived to admission and 93 (7.0%%) survived to discharge. Upon univariate analysis, there was no difference in survival between intubated and non intubated groups (6.5%% vs 10.0%%, OR == 0.63, 95%% CI 0.37,1.08). For patients initially in ventricular fibrillation/ventricular tachycardia (VT/VF), in a multivariate Logit model, intubation significantly decreased survival to discharge, adjusted odds ratio (OR) == 0.52 (95%% confidence interval 0.27, 0.998). Intubated non-VF patients were more likely to survive to admission, adjusted OR 2.96 (1.04, 8.43), but not to discharge (1.8%% vs. 1.0%%, p == 1.0). Conclusion. This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.
Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis
Efstathios Karamanosa1 c1, Peep Talvinga1, Dimitra Skiadaa1, Melanie Osbya1, Kenji Inabaa1, Lydia Lama1, Ozgur Albuza1 and Demetrios Demetriadesa1
a1 Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Abstract
Introduction Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant.
Hypothesis Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.
Methods This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS).
Results Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS.
Conclusion In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.
E Karamanos, P Talving, D Skiada, M Osby, K Inaba, L Lam, O Albuz, D Demetriades. Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis. Prehosp Disaster Med. 2013;28(6):1-5 .
(Received November 20 2012)
(Accepted February 18 2013)
(Online publication December 13 2013)
Prehospital Intubation Does Not Decrease Complications in the Penetrating Trauma Patient
Authors: Taghavi, Sharven; Vora, Halley P.; Jayarajan, Senthil N.; Gaughan, John P.; Pathak, Abhijit S.; Santora, Thomas A.; Goldberg, Amy J.
Abstract:
Source: The American Surgeon, Volume 80, Number 1, January 2014, pp. 9-14(6)
Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P < 0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.
Document Type: Research Article
Affiliations: Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
Publication date: January 1, 2014
Assessing the Impact of Prehospital Intubation on Survival in Out-of-Hospital Cardiac Arrest
January-March 2011, Vol. 15, No. 1 , Pages 44-49 (doi:10.3109/10903127.2010.514090)
Joshua Egly, Don Custodio, Nathan Bishop, Michael Prescott, Victoria Lucia, Raymond E. Jackson, and Robert A. Swor
From the Department of Emergency Medicine (JE, REJ, RAS) and the Department of Outcomes Research (VL), William Beaumont Hospital, Royal Oak, Michigan; the Department of Emergency Medicine (DC), Borgess Medical Center, Kalamazoo, Michigan; the Department of Emergency Medicine (NB), Spectrum Health Medical Center, Grand Rapids, Michigan; and the Department of Emergency Medicine (MP), St. Mary's Medical Center, Livonia, Michigan.
Presented at the American College of Emergency Physicians annual meeting, Chicago, Illinois, October 2007, and at the National Association of EMS Physicians annual meeting, Phoenix, Arizona, January 2008.
Department of Emergency Medicine, William Beaumont Hospital is an affiliate of Wayne State University School of Medicine, Detroit, Michigan.
Abstract
There is a developing body of literature documenting adverse survival outcome of out-of-hospital endotracheal intubation for critical multiple trauma and head injury patients. Objective. To compare the rates of survival to hospital admission and discharge of nontraumatic out-of-hospital cardiac arrest (OHCA) patients who received successful out-of-hospital endotracheal intubation and those who were not intubated. Methods. We conducted a retrospective analysis from an ongoing database of OHCA patients brought to a large suburban tertiary care emergency department by paramedic services between 1995 and 2006. We dichotomized patients by whether they were successfully endotracheally intubated or not prior to hospital arrival. Utstein style cardiac arrest variables were abstracted for all cases. All survivors to hospital admission were reviewed to exclude those patients in whom intubation was not attempted or unnecessary, such as those who had successful first-shock recovery of spontaneous circulation. We used chi square and logistic regression techniques for analysis, using survival to discharge as the primary outcome and survival to admission as a secondary outcome. Results. There were 1,515 total cases with 33 early survivors excluded. Overall, 1,220 (86.2%%) were intubated; of those intubated, 270 (20.2%%) survived to admission and 93 (7.0%%) survived to discharge. Upon univariate analysis, there was no difference in survival between intubated and non intubated groups (6.5%% vs 10.0%%, OR == 0.63, 95%% CI 0.37,1.08). For patients initially in ventricular fibrillation/ventricular tachycardia (VT/VF), in a multivariate Logit model, intubation significantly decreased survival to discharge, adjusted odds ratio (OR) == 0.52 (95%% confidence interval 0.27, 0.998). Intubated non-VF patients were more likely to survive to admission, adjusted OR 2.96 (1.04, 8.43), but not to discharge (1.8%% vs. 1.0%%, p == 1.0). Conclusion. This observational study in an unselected population shows that patients in VF/VT arrest who underwent out-of-hospital intubation were less likely to survive to discharge than those not intubated. Out-of-hospital intubation of patients with non-VF arrest was associated with an increased rate of survival to admission, but not survival to discharge. Future prospective studies are needed to define the role of out-of-hospital endotracheal intubation in cardiac arrest patients.
Is Prehospital Endotracheal Intubation Associated with Improved Outcomes In Isolated Severe Head Injury? A Matched Cohort Analysis
Efstathios Karamanosa1 c1, Peep Talvinga1, Dimitra Skiadaa1, Melanie Osbya1, Kenji Inabaa1, Lydia Lama1, Ozgur Albuza1 and Demetrios Demetriadesa1
a1 Division of Acute Care Surgery (Trauma, Emergency Surgery and Surgical Critical Care), Keck School of Medicine, University of Southern California, Los Angeles, California USA
Abstract
Introduction Prehospital endotracheal intubation (ETI) following traumatic brain injury in urban settings is controversial. Studies investigating admission arterial blood gas (ABG) patterns in these instances are scant.
Hypothesis Outcomes in patients subjected to divergent prehospital airway management options following severe head injury were studied.
Methods This was a retrospective propensity-matched study in patients with isolated TBI (head Abbreviated Injury Scale (AIS) ≥ 3) and Glasgow Coma Scale (GCS) score of ≤ 8 admitted to a Level 1 urban trauma center from January 1, 2003 through October 31, 2011. Cases that had prehospital ETI were compared to controls subjected to oxygen by mask in a one to three ratio for demographics, mechanism of injury, tachycardia/hypotension, Injury Severity Score, type of intracranial lesion, and all major surgical interventions. Primary outcome was mortality and secondary outcomes included admission gas profile, in-hospital morbidity, ICU length of stay (ICU LOS) and hospital length of stay (HLOS).
Results Cases (n = 55) and controls (n = 165) had statistically similar prehospital and in-hospital variables after propensity matching. Mortality was significantly higher for the ETI group (69.1% vs 55.2% respectively, P = .011). There was no difference in pH, base deficit, and pCO2 on admission blood gases; however the ETI group had significantly lower pO2 (187 (SD = 14) vs 213 (SD = 13), P = .034). There was a significantly increased incidence of septic shock in the ETI group. Patients subjected to prehospital ETI had a longer HLOS and ICU LOS.
Conclusion In isolated severe traumatic brain injury, prehospital endotracheal intubation was associated with significantly higher adjusted mortality rate and worsened admission oxygenation. Further prospective validation of these findings is warranted.
E Karamanos, P Talving, D Skiada, M Osby, K Inaba, L Lam, O Albuz, D Demetriades. Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis. Prehosp Disaster Med. 2013;28(6):1-5 .
(Received November 20 2012)
(Accepted February 18 2013)
(Online publication December 13 2013)
Prehospital Intubation Does Not Decrease Complications in the Penetrating Trauma Patient
Authors: Taghavi, Sharven; Vora, Halley P.; Jayarajan, Senthil N.; Gaughan, John P.; Pathak, Abhijit S.; Santora, Thomas A.; Goldberg, Amy J.
Abstract:
Source: The American Surgeon, Volume 80, Number 1, January 2014, pp. 9-14(6)
Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P < 0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.
Document Type: Research Article
Affiliations: Department of Surgery, Temple University Hospital, Philadelphia, Pennsylvania, USA
Publication date: January 1, 2014
