Prehospital tracheal intubation versus emergency department intubation for trauma patients

Background: Patients with severe traumatic brain injury [TBI] are at high risk for airway obstruction and hypoxia at the accident scene, and routine prehospital endotracheal intubation has been widely advocated. Aim of the Study: to evaluate and compare the outcome and mortality rates of trauma patients undergoing Prehospital Tracheal Intubationversus those undergoing Emergency Department Intubation

---

Methods: A literature search was carried out on MEDLINE [including MEDLINE in-process], CINAHL, Embase and the Cochrane Library [from 1990 to October 2017]. Databases using "Prehospital Tracheal Intubation", "Emergency Department Intubation ", "Adults? trauma", and "mortality" as a MeSH heading and as text word. High yield journals were also had searched

---

Results: Eleven studies enrolling 17317 patients were included, out of which 4545 underwent PTI while 12772 underwent EDI. Median mortality rate in patients undergoing pre-hospital intubation was 52.12% [7.8-90.16%], compared to 27.98% [6.25-41.56%] in patients undergoing intubation in the emergency department. The overall quality of evidence was very low. Six of the eleven studies found a significantly higher mortality rate after pre-hospital intubation whilst five found no significant differences

---

Conclusion: Study outcome suggests that EDI was superior to PHI. Nevertheless, prehospital intubation was a marker for more severely ill patients who would have had higher mortality thus, the suggestion of the association between pre-hospital intubation and a higher mortality rate does not essentially oppose the importance of the intervention, but rather a need for further investigation of the possible causes for this finding