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4th World Trauma Congress Article
Physician-based on-scene airway management in severely injured patients and in-hospital consequences: is the misplaced intubation an underestimated danger in trauma management?
  1. Orkun Özkurtul1,
  2. Manuel F Struck2,
  3. Johannes Fakler1,
  4. Michael Bernhard3,
  5. Silja Seinen1,
  6. Hermann Wrigge2,
  7. Christoph Josten1
  1. 1 Department of Orthopedic, Trauma, and Plastic Surgery, University Hospital of Leipzig, Leipzig, Germany
  2. 2 Department of Anesthesiology and Intensive Care Medicine, University Hospital of Leipzig, Leipzig, Germany
  3. 3 Emergency Department, University Hospital of Düsseldorf, Moorenstr, Germany
  1. Correspondence to Dr Orkun Özkurtul, Department of Orthopedic, Trauma, and Plastic Surgery, University of Leipzig, Leipzig 04109, Germany; oezkurtul{at}medizin.uni-leipzig.de

Abstract

Background Endotracheal intubation (ETI) is the gold standard for the out-of-hospital emergency airway management in severely injured patients. Due to time-critical circumstances, poor patient presentation and hostile environments, it may be prone for mechanical complications and failure.

Methods In a retrospective study (January 2011 to December 2013), all patients who underwent out-of-hospital ETI before admittance to a level 1 trauma center were analyzed consecutively. Patients with supraglottic airways, being under cardiopulmonary resuscitation and interfacility transports were excluded. The main study endpoint was the incidence of unrecognized tube malposition; secondary endpoints were Glasgow Outcome Scale (GOS) and in-hospital mortality adjusted to on-scene Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Abbreviated Injury Scale head (AIS head), and on-scene time.

Results Out of 1176 patients, 151 underwent out-of-hospital ETI. At hospital admission, tube malpositions were recognized in nine patients (5.9%). Accidental and unrecognized esophageal intubation was detected in five patients (3.3%) and bronchial intubation in four patients (2.7%). Although ISS (p=0.053), AIS head (p=0.469), on-scene GCS (p=0.151), on-scene time (p=0.530), GOS (p=0.748) and in-hospital mortality (p=0.431) were similar compared with correctly positioned ETI tubes, three esophageal intubation patients died due to hypoxemic complications.

Discussion In our study sample, out-of-hospital emergency ETI in severely injured patients was associated with a considerable tube misplacement rate. For safety, increased compliance to consequently use available technologies (eg, capnography, video laryngoscopy) for emergency ETI should be warranted.

Level of evidence Level of Evidence IIA.

  • intubation
  • out-of-hospital
  • polytrauma
  • severely injured
  • misplacement
  • esophageal

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2018-000271

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    Footnotes

    • Contributors OÖ conceived the study and designed the protocol. OÖ, SS and JF collected the data. OÖ, MFS and MB analyzed the data. CJ and HW supervised the conduct of the study and data collection. OÖ, MFS and MB drafted the article, and all authors contributed substantially to its revision. OÖ take responsibility for the article as a whole. All authors read and approved the final article.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval The study was performed in accordance with the Declaration of Helsinki and approved by the ethics committee of the Medical Faculty of the University of Leipzig with the reference number 137-15-20042015.

    • Provenance and peer review Not commissioned; externally peer reviewed.