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Prehospital endotracheal intubation and chest tubing does not prolong the overall resuscitation time of severely injured patients: a retrospective, multicentre study of the Trauma Registry of the German Society of Trauma Surgery
  1. Martin Kulla1,
  2. Matthias Helm1,
  3. Rolf Lefering2,
  4. Felix Walcher3
  1. 1Department of Anaesthesia and Critical Care Medicine, Federal Armed Forces Medical Centre Ulm, Ulm, Germany
  2. 2Institute for Research in Operative Medicine (IFOM), University of Witten / Herdecke, Cologne, Germany
  3. 3Department of Trauma Surgery, Johann Wolfgang Goethe University Frankfurt, Frankfurt am Main, Germany
  1. Correspondence to Dr Martin Kulla, Department of Anaesthesia and Critical Care Medicine, Federal Armed Forces Medical Centre Ulm, Oberer Eselsberg 40, D-89081 Ulm, Germany; mail{at}


Background The aim of this study was to determine whether prehospital endotracheal intubation (ETI) and chest tube placement is unnecessarily time consuming in severely injured patients.

Patients and Methods A retrospective, multicentre study including all adult patients (ISS ≥9; 2002–7) of the Trauma Registry of the German Society of Trauma Surgery who were not secondarily transferred to a trauma centre and received a definitive airway and a chest tube. Creating four groups: AA (n=963) receiving ETI and chest tube on scene, AB (n=1547) ETI performed in the prehospital setting but chest tubing later in the emergency department (ED) and BB (n=640) receiving both procedures in the ED. The BA collective (ETI performed in the ED, but chest tubing on scene) was excluded from the study because of the small sample size (n=41). The trauma resuscitation time (TRT), demographic data, injuries, treatment and outcome of the remaining three collectives were compared.

Results The prehospital TRT of the AA collective was longer than the AB and BB subgroups (80±37 min vs 77±44 min 65±46 min; p<0.01). Although the AA and AB subgroups were more severely injured (ISS 35±15 vs 38±15 vs 31±12; p<0.01) and showed poorer vital parameters on scene, the overall TRT (accident until end of ED treatment) were equal for all three groups (152±59 min vs 151±62 min vs 148±68 min; p=0.07). The TRISS adjusted mortality was also equal in all three groups.

Conclusions In a physician-based emergency medical service, prehospital ETI and chest tube placement do not prolong the total TRT of severely injured patients.

  • Airway
  • chest tube
  • clincial management
  • endotracheal intubation
  • major trauma
  • major trauma management
  • on-scene resuscitation
  • paramedics
  • pneumothorax
  • prehospital care
  • respiratory
  • scoop and run
  • trauma
  • trauma resuscitation time

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  • The first two authors have contributed equally to the paper.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.