title: Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study.
abstract: BACKGROUND
  Guidelines recommend that patients with brain trauma with a Glasgow Coma Scale (GCS) score of less than 9 should have an airway established. Hypoxia, hypotension and hypertension as well as hypoventilation and hyperventilation may worsen outcome in these patients.
  
  
  OBJECTIVE
  The objectives were to investigate guideline adherence, reasons for nonadherence and the incidences of complications related to prehospital advanced airway management in patients with traumatic brain injury.
  
  
  METHODS
  We prospectively collected data from eight anaesthesiologist-staffed prehospital critical care teams in the Central Denmark Region according to the Utstein-style template.
  
  
  RESULTS
  Among 1081 consecutive prehospital advanced airway management patients, we identified 54 with a traumatic brain injury and an initial GCS score of less than 9. Guideline adherence in terms of airway management was 92.6%. The reasons for nonadherence were the patient's condition, anticipated difficult airway management and short distance to the emergency department. Following rapid sequence intubation (RSI), 11.4% developed oxygen saturation below 90%, 9.1% had a first post-RSI systolic blood pressure below 90 mmHg and 48.9% had a first post-RSI systolic blood pressure below 120 mmHg. The incidence of hypertension following prehospital RSI was 4.5%. The incidence of postendotracheal intubation hyperventilation was as high as 71.1%.
  
  
  CONCLUSIONS
  The guideline adherence was high. The incidences of post-RSI hypoxia and systolic blood pressure below 90 compare with the results reported from other physician-staffed prehospital services. The incidence of systolic blood pressure below 120 as well as that of hyperventilation following prehospital endotracheal intubation in patients with traumatic brain injury call for a change in our current practice.
authors.affiliation: aDepartment of Research and Development, Norwegian Air Ambulance Foundation, Drøbak, Norway bPre-Hospital Critical Care Team, Department of Anaesthesiology, Viborg Regional Hospital, Viborg cDepartment of Pre-hospital Medical Services, Central Denmark Region dPre-Hospital Critical Care Team eCentre for Emergency Medicine Research fDepartment of Anaesthesiology, Aarhus University Hospital, Aarhus N, Denmark.
authors.forename: Leif
authors.initials: L
authors.lastname: Rognås
authors.forename: Troels M
authors.initials: TM
authors.lastname: Hansen
authors.forename: Hans
authors.initials: H
authors.lastname: Kirkegaard
authors.forename: Else
authors.initials: E
authors.lastname: Tønnesen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D015600:Glasgow Coma Scale; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D006985:Hyperventilation / Q000453:epidemiology; D007223:Infant; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D055815:Young Adult