Prehospital rapid sequence intubation for head trauma: conditions for a successful program

Area of Science:

• Emergency Medicine
• Trauma Surgery
• Anesthesiology

Background:

• Concerns exist regarding the safety and efficacy of prehospital rapid sequence intubation (RSI) in head trauma patients.
• This study addresses these concerns by evaluating RSI in a specialized paramedic group.

Purpose of the Study:

• To determine the success rate of prehospital RSI in critically injured trauma patients.
• To identify complications and transport delays associated with prehospital RSI.
• To assess the impact of RSI on patient oxygenation.

Main Methods:

• Data from a helicopter paramedic group (1999-2003) were merged with Level I trauma center registry data.
• Institutional Review Board approval was obtained for data analysis.
• RSI success rate, oxygenation impact, transport delays, and complications were analyzed. Attempted RSI was defined as laryngoscope insertion into the oropharynx.

Main Results:

• 169 out of 175 attempted RSI cases (96.6%) were successful in the prehospital setting.
• Most successful intubations occurred within three attempts (96%).
• Complications included 2.9% right mainstem intubations and 1.2% tube dislodgments; no esophageal intubations occurred. A mean of 6 minutes was added to scene time.

Conclusions:

• Prehospital RSI for trauma patients can be performed safely and effectively with low complication rates.
• Effective prehospital airway management relies on focused training, regular experience, and close monitoring of providers.
• This approach is crucial for managing patients with traumatic brain injuries.