Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation.
BACKGROUND
Few data exist supporting a survival benefit to prehospital endotracheal intubation (ETI) over bag-valve-mask ventilation (BVM) in trauma patients.


METHODS
Data were reviewed from all trauma patients transported to our Level I trauma center receiving prehospital ETI or BVM. Mortality was adjusted by age, Revised Trauma Score, Injury Severity Score, and mechanism of injury (penetrating vs. blunt).


RESULTS
Of 5,773 patients, 316 (5.5%) had ETI and 217 (3.8%) had BVM. Patients receiving ETI were significantly more like to die (88.9% vs. 30.9%, p < 0.0001). When corrected for Injury Severity Score, Revised Trauma Score, and mechanism of injury, ETI was associated with similar or greater mortality than BVM. ETI patients had longer prehospital times (22.0 vs. 20.1 minutes, p = 0.0241).


CONCLUSIONS
In our trauma system, when corrected for mechanism and severity of anatomic and physiologic injury, ETI confers no survival advantage over BVM and slightly increases prehospital time.
Stockinger
Zsolt T
ZT
Department of Surgery SL-22, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA. stockinger@surgery.tulane.edu
McSwain
Norman E
NE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004867:Equipment Design; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007442:Intubation, Intratracheal / Q000401:mortality*; D008145:Louisiana; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D012121:Respiration, Artificial / Q000295:instrumentation*; D012189:Retrospective Studies; D015996:Survival Rate; D013898:Thoracic Injuries / Q000401:mortality / Q000628:therapy*; D014193:Trauma Centers / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy