Paramedic rapid sequence intubation for severe traumatic brain injury: perspectives from an expert panel.
Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice. The interpretation of this panel can be summarized as follows: (1) the existing literature regarding paramedic RSI is inconclusive, and apparent differences in outcome can be explained by use of different methodologies and variability in comparison groups; (2) the use of Glasgow Coma Scale score alone to identify TBI patients requiring RSI is limited, with additional research needed to refine our screening criteria; (3) suboptimal RSI technique as well as subsequent hyperventilation may account for some of the mortality increase reported with the procedure; (4) initial and ongoing training as well as experience with RSI appear to affect performance; and (5) the success of a paramedic RSI program is dependent on particular EMS and trauma system characteristics.
Davis
Daniel P
DP
Department of Emergency Medicine, University of California at San Diego, San Diego, California 92103-8676, and Trauma Services, Inova Regional Trauma Center, Inova Fairfax Hospital, Falls Church, VA, USA. davismd@cox.net
Fakhry
Samir M
SM
Wang
Henry E
HE
Bulger
Eileen M
EM
Domeier
Robert M
RM
Trask
Arthur L
AL
Bochicchio
Grant V
GV
Hauda
William E
WE
Robinson
Linda
L
D001930:Brain Injuries; D004632:Emergency Medical Services; D004634:Emergency Medical Technicians; D006801:Humans; D007440:Intubation / Q000379:methods*; D015599:Trauma Severity Indices; D014481:United States