OBJECTIVE: To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. BACKGROUND: Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatose patients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes. METHODS: In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge. RESULTS: A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge. CONCLUSIONS: In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
RCT Entities:
OBJECTIVE: To determine whether paramedic rapid sequence intubation in patients with severe traumatic brain injury (TBI) improves neurologic outcomes at 6 months compared with intubation in the hospital. BACKGROUND: Severe TBI is associated with a high rate of mortality and long-term morbidity. Comatosepatients with TBI routinely undergo endo-tracheal intubation to protect the airway, prevent hypoxia, and control ventilation. In many places, paramedics perform intubation prior to hospital arrival. However, it is unknown whether this approach improves outcomes. METHODS: In a prospective, randomized, controlled trial, we assigned adults with severe TBI in an urban setting to either prehospital rapid sequence intubation by paramedics or transport to a hospital emergency department for intubation by physicians. The primary outcome measure was the median extended Glasgow Outcome Scale (GOSe) score at 6 months. Secondary end-points were favorable versus unfavorable outcome at 6 months, length of intensive care and hospital stay, and survival to hospital discharge. RESULTS: A total of 312 patients with severe TBI were randomly assigned to paramedic rapid sequence intubation or hospital intubation. The success rate for paramedic intubation was 97%. At 6 months, the median GOSe score was 5 (interquartile range, 1-6) in patients intubated by paramedics compared with 3 (interquartile range, 1-6) in the patients intubated at hospital (P = 0.28).The proportion of patients with favorable outcome (GOSe, 5-8) was 80 of 157 patients (51%) in the paramedic intubation group compared with 56 of 142 patients (39%) in the hospital intubation group (risk ratio, 1.28; 95% confidence interval, 1.00-1.64; P = 0.046). There were no differences in intensive care or hospital length of stay, or in survival to hospital discharge. CONCLUSIONS: In adults with severe TBI, prehospital rapid sequence intubation by paramedics increases the rate of favorable neurologic outcome at 6 months compared with intubation in the hospital.
Authors: Douglas L Andrusiek; Danny Szydlo; Susanne May; Karen J Brasel; Joseph Minei; Rardi van Heest; Russell MacDonald; Martin Schreiber Journal: Prehosp Emerg Care Date: 2015-04-24 Impact factor: 3.077
Authors: U M Mauer; M Fischer; E Kehrberger; H Moecke; S Prückner; H Trentzsch; B Urban; H Marung Journal: Unfallchirurg Date: 2016-11 Impact factor: 1.000
Authors: Jonathan Marehbian; Susanne Muehlschlegel; Brian L Edlow; Holly E Hinson; David Y Hwang Journal: Neurocrit Care Date: 2017-12 Impact factor: 3.210
Authors: Jose-Miguel Yamal; H Julia Hannay; Shankar Gopinath; Imoigele P Aisiku; Julia S Benoit; Claudia S Robertson Journal: J Neurotrauma Date: 2019-05-23 Impact factor: 5.269
Authors: Ben Meadley; Alexander Olaussen; Ashleigh Delorenzo; Nick Roder; Caroline Martin; Toby St Clair; Andrew Burns; Emma Stam; Brett Williams Journal: BMC Emerg Med Date: 2017-06-17
Authors: Kurt R Denninghoff; Tomas Nuño; Qi Pauls; Sharon D Yeatts; Robert Silbergleit; Yuko Y Palesch; Lisa H Merck; Geoff T Manley; David W Wright Journal: Prehosp Emerg Care Date: 2017-05-10 Impact factor: 3.077
Authors: Daniel W Spaite; Bentley J Bobrow; Uwe Stolz; Duane Sherrill; Vatsal Chikani; Bruce Barnhart; Michael Sotelo; Joshua B Gaither; Chad Viscusi; P David Adelson; Kurt R Denninghoff Journal: Acad Emerg Med Date: 2014-08-11 Impact factor: 3.451
Authors: Henry E Wang; Siobhan P Brown; Russell D MacDonald; Shawn K Dowling; Steve Lin; Daniel Davis; Martin A Schreiber; Judy Powell; Rardi van Heest; Mohamud Daya Journal: Emerg Med J Date: 2013-01-26 Impact factor: 2.740