Abstract
The aim of this study was to determine complication rates and possible risk factors of expert-performed endotracheal intubation (ETI) in patients with trauma, in both the prehospital setting and the emergency department. We also investigated how the occurrence of ETI-related complications affected the survival of trauma patients. This single-center retrospective observational study included all injured patients who underwent anesthesiologist-performed ETI from 2007 to 2017. ETI-related complications were defined as hypoxemia, unrecognized esophageal intubation, regurgitation, cardiac arrest, ETI failure rescued by emergency surgical airway, dental trauma, cuff leak, and mainstem bronchus intubation. Of the 537 patients included, 23.5% experienced at least one complication. Multivariable logistic regression analysis revealed that low Glasgow Coma Scale Score (adjusted odds ratio [AOR], 0.93; 95% confidence interval [CI], 0.88–0.98), elevated heart rate (AOR, 1.01; 95% CI, 1.00–1.02), and three or more ETI attempts (AOR, 15.71; 95% CI, 3.37–73.2) were independent predictors of ETI-related complications. We also found that ETI-related complications decreased the likelihood of survival of trauma patients (AOR, 0.60; 95% CI, 0.38–0.95), independently of age, male sex, Injury Severity Score, Glasgow Coma Scale Score, and off-hours presentation. Our results suggest that airway management in trauma patients carries a very high risk; this finding has implications for the practice of airway management in injured patients.
Highlights
Traumatic injury is the leading cause of death and disability among young people and places a tremendous economic burden on society [1, 2]
223 patients who received ongoing cardiopulmonary resuscitation, 30 patients who were transported from other facilities, and four patients who underwent initial airway management by emergency surgery
Complete records were available for all patients and no data were missing from the analyses
Summary
Traumatic injury is the leading cause of death and disability among young people and places a tremendous economic burden on society [1, 2]. And appropriate airway management is a vital lifesaving measure in severely injured patients [3] because airway compromise is a significant cause of poor outcomes in this population [4]. Trauma patients have a very high risk of hemodynamic instability, restlessness, inadequate evaluation, and the need for cervical spine protection, all of which contribute to difficult ETI [5,6,7,8,9]. This challenging procedure should be delegated to a skilled laryngoscopist who performs ETI frequently, such as an anesthesiologist. To better understand the risks of trauma airway management, it is important to clarify the incidence and associated factors of expert-performed ETI-related complications.
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