Official websites use. Share sensitive information only on official, secure websites. Endotracheal intubation is widely used for airway management in a prehospital setting, despite a lack of controlled trials demonstrating a positive effect on survival or neurological outcome in adult patients. The benefits, in term of outcomes of invasive airway management before reaching hospital, remain controversial. However, inadequate airway management in this patient population is the primary cause of preventable mortality.
An increase in intubation failures and in the rate of complications in trauma patients should induce us to improve airway management skills at the scene of trauma. If the addition of emergency physicians to a prehospital setting is to have any influence on outcome, further studies are merited.
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However, it has been established that sedation with rapid sequence intubation is superior in terms of success, complications and rates of intubation difficulty. Orotracheal intubation with planned neuromuscular blockade and in-line cervical alignment remains the safest and most effective method for airway control in patients who are severely injured.
In a retrospective observational study recently published in British Medical Journal , Lockey et al. They looked at the records of patients registered in a helicopter emergency medical service database over six years; of these, had data on survival. Out of patients, only one survived 0.
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From this, the authors associate non-drug-assisted airway management with poor prognosis in trauma patients. The study design in the paper by Lockey et al. It is also not clear from the authors' comments whether they are calling into question the procedure itself or the capacities of those performing it. Nevertheless, it did highlight the quandaries surrounding airway management in trauma patients before reaching hospital, and raised two fundamental questions.
