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Related Experiment Video

Updated: Jul 5, 2025

A Bedside, Single Burr Hole Approach to Multimodality Monitoring in Severe Brain Injury
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EMS Treatment Guidelines in Major Traumatic Brain Injury With Positive Pressure Ventilation.

Joshua B Gaither1,2, Daniel W Spaite1,2, Bentley J Bobrow3

  • 1Arizona Emergency Medicine Research Center, College of Medicine-Phoenix, The University of Arizona, Phoenix.

JAMA Surgery
|January 24, 2024
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Implementing prehospital traumatic brain injury (TBI) guidelines improved survival for severe TBI patients receiving positive pressure ventilation (PPV). These findings support current recommendations for aggressive airway management in severe TBI care.

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Area of Science:

  • Emergency Medicine
  • Neurosurgery
  • Critical Care Medicine

Background:

  • The Excellence in Prehospital Injury Care (EPIC) study showed improved survival for severe traumatic brain injury (TBI) patients after guideline implementation.
  • The impact of these guidelines on patients receiving positive pressure ventilation (PPV) was previously unknown.

Purpose of the Study:

  • To assess the association between prehospital TBI evidence-based guideline implementation and survival rates.
  • Specifically focused on patients who received prehospital PPV.

Main Methods:

  • A subanalysis of the EPIC study using a before/after controlled design.
  • Included patients who received prehospital PPV, comparing preimplementation and postimplementation cohorts.
  • Logistic regression was used for outcome comparison, stratified by TBI severity.

Main Results:

  • Overall survival to admission improved (aOR, 1.59), but survival to discharge did not significantly change.
  • In severe TBI patients receiving PPV, survival to admission (aOR, 6.44) and discharge (aOR, 3.52) significantly increased.
  • These benefits were observed regardless of airway intervention type (basic or advanced).

Conclusions:

  • Prehospital guideline implementation is independently associated with improved survival in severe TBI patients receiving PPV.
  • Supports current guidelines recommending aggressive management of hypoxia and hyperventilation in severe TBI.
  • Findings are relevant for both basic and advanced airway interventions in prehospital TBI care.