Admission Hypothermia in Trauma Patients Undergoing Prehospital Tracheal Intubation: 15-Year Review of a Level-1...

The adverse role of accidental hypothermia in trauma patients has been studied for decades while patients undergoing prehospital tracheal intubation are at particular risk due to impaired temperature autoregulation. The primary objective of the study was to determine the prevalence and risk factors associated with admission hypothermia (body temperature <35 °C) at the emergency department. Secondary objectives included the assessment of the association of hypothermia with all-cause mortality, transfusion requirement, intensive care unit length of stay (ICU LOS), and duration of mechanical ventilation.

In a single-center retrospective analysis, trauma patients aged ≥16 years undergoing prehospital tracheal intubation were analyzed for admission temperature between 2008 and 2022. Multivariable logistic regression analyses and linear regression analyses were used to examine the association between risk factors, hypothermia, and outcomes.

A total of 851 patients (72% male) with a median age of 50 years, a median injury severity score (ISS) of 27 points, and a 30-day mortality of 30% were included. The median admission body temperature was 35.1 °C, and 366 patients (43%) were hypothermic. Independent risk factors for hypothermia were outside temperature (OR 1.03 per one degree Celsius decrease, 95% CI 1.01 to 1.05), helicopter transport (OR 2.36, 95% CI 1.68 to 3.33), ISS score (OR 1.03, 95% CI 1.01 to 1.04), admission shock (OR 3.48, 95% CI 2.27 to 5.34), admission acidosis (OR 1.69, 95% CI 1.04 to 2.73), and admission coagulopathy (OR 1.85, 95% CI 1.25 to 2.76). Multivariable outcome analyses revealed significant associations of hypothermia with 24-h mortality (OR 6.6, 95% CI 3.2 to 13.64), 30-day mortality (OR 3.81, 95% CI 2.35 to 6.18), massive transfusion (OR 2.94, 95% CI 1.78 to 4.86), ICU LOS in survivors (beta weight 3.15, 95% CI 0.73 to 5.58) and duration of mechanical ventilation in survivors (beta weight 2.65, 95% CI 0.89 to 4.41).

The present findings suggest that a significant proportion of trauma patients who require prehospital tracheal intubation experience hypothermia, which is associated with critical injury severity and high mortality rates. These associations suggest the potential for implementing preventive measures and rewarming strategies until arrival at the emergency department, necessitating further investigation.