Airway management in acutely poisoned patients with Glasgow Coma Scale less than 9: a retrospective cohort study

A Glasgow Coma Scale (GCS) ≤ 8 is frequently used to guide prehospital intubation, but its generalizability to acutely poisoned patients is uncertain. We compared outcomes of poisoned patients with GCS ≤ 8 managed with or without prehospital intubation.

We retrospectively included poisoned patients with a GCS ≤ 8 found as helpless persons in public settings and admitted to a tertiary toxicology center. Patients were grouped by prehospital intubation status. Clinical characteristics, management, and outcomes were analyzed using nonparametric and categorical tests, the analyses were exploratory due to the limited sample size.

Among 84 patients, 10 (11.9%) were intubated prehospitally, and 74 (88.1%) were not. Median GCS was lower in intubated patients (3 vs. 7). Aspiration pneumonitis in non-intubated patients was rare (6.8%) and did not differ significantly between groups. Vasopressor therapy within 24 h was required in one of 74 (1.4%) non-intubated patients and two of 10 (20.0%) intubated patients. Antidotes were frequently administered, especially in non-intubated patients, predominantly in the prehospital setting. Two non-intubated patients (2.7%) required delayed mechanical ventilation. No deaths occurred.

Non-intubated patients showed favorable outcomes with low complication rates and infrequent delayed intubations, while antidotes were frequently administered in both the prehospital and in-hospital settings. These results suggest that GCS alone may be insufficient to guide airway management in poisoning, supporting an individualized, clinically guided approach.