Interventions associated with survival after prehospital intubation in the deployed combat setting.
The American journal of emergency medicine · 2024-02-07 · Observational study
Abstract
INTRODUCTION: Airway compromise is the second leading cause of potentially preventable death on the battlefield. Prehospital airway management is often unavoidable in a kinetic combat environment and expected to increase in future wars where timely evacuation will be unreliable and air superiority not guaranteed. We compared characteristics of survivors to non-survivors among combat casualties undergoing prehospital airway intubation. MATERIALS AND METHODS: We requested all Department of Defense Trauma Registry (DODTR) encounters during 2007-2023 with documentation of any airway intervention or assessment within the first 72-h after injury. We conducted a retrospective cohort study of all casualties with intubation documented in the prehospital setting. We used descriptive and inferential statistical analysis to compare survivors through 7 days post injury versus non-survivors. We constructed 3 multivariable logistic regression models to test for associations between interventions and 7-day survival after adjusting for injury severity score, mechanism of injury, and receipt of sedatives, paralytics, and blood products. RESULTS: There were 1377 of 48,301 patients with documentation of prehospital intubation in a combat setting. Of these, 1028 (75%) survived through 7 days post injury. Higher proportions of survivors received ketamine, paralytic agents, parenteral opioids, and parenteral benzodiazepines; there was no difference in the proportions of survivors versus non-survivors receiving etomidate. The multivariable models consistently demonstrated positive associations between 7-day survival and receipt of non-depolarizing paralytics and opioid analgesics. CONCLUSIONS: We found an association between non-depolarizing paralytic and opioid receipt with 7-day survival among patients undergoing prehospital intubation. The literature would benefit from future multi-center randomized controlled trials to establish optimal pharmacologic strategies for trauma patients undergoing prehospital intubation.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Anaesthetics · Analgesics · Other benzodiazepines & Z-drugs · Blood products · Fluids & blood · Endotracheal intubation · Ketamine · Military & tactical · Mortality & survival · Muscle relaxants · Sedatives & anxiolytics
Related articles
- [Acute treatment of patients with severe traumatic brain injury]. (Anaesthesist, 2015)
- Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study. (Scand J Trauma Resusc Emerg Med, 2023)
- Ketamine Use in Operation Enduring Freedom. (Mil Med, 2021)
- A Comparison of Injury Patterns and Interventions among US Military Special Operations Versus Conventional Forces Combatants. (Med J (Ft Sam Houst Tex), 2023)
- Combat MEDEVAC: A comparison of care by provider type for en route trauma care in theater and 30-day patient outcomes. (J Trauma Acute Care Surg, 2016)
- Experience With Prehospital Damage Control Capability in Modern Conflict: Results From Surgical Resuscitation Team Use. (J Spec Oper Med, 2017)