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Original research
Prehospital endotracheal intubation for traumatic out-of-hospital cardiac arrest and improved neurological outcomes
  1. Ryo Yamamoto1,
  2. Masaru Suzuki2,
  3. Ryo Takemura3,
  4. Junichi Sasaki1
  1. 1Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan
  2. 2Department of Emergency Medicine, Ichikawa General Hospital, Chiba, Japan
  3. 3Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
  1. Correspondence to Dr Ryo Yamamoto; ryo.yamamoto{at}gmail.com

Abstract

Background Patients with traumatic out-of-hospital cardiac arrest (t-OHCA) require on-scene airway management to maintain tissue oxygenation. However, the benefits of prehospital endotracheal intubation remain unclear, particularly regarding neurological outcomes. Therefore, this study aimed to evaluate the association between prehospital intubation and favourable neurological outcomes in patients with t-OHCA.

Methods This retrospective cohort study used a Japanese nationwide trauma registry from 2019 to 2021. It included adult patients diagnosed with traumatic cardiac arrest on emergency medical service arrival. Glasgow Outcome Scale (GOS) scores, survival at discharge and presence of signs of life on hospital arrival were compared between patients with prehospital intubation and those with supraglottic airway or manual airway management. Inverse probability weighting with propensity scores was used to adjust for patient, injury, treatment and institutional characteristics, and the effects of intubation on outcomes averaged over baseline covariates were shown as marginal ORs.

Results A total of 1524 patients were included in this study, with 370 undergoing intubation before hospital arrival. Prehospital intubation was associated with favourable neurological outcomes at discharge (GOS≥4 in 5/362 (1.4%) vs 10/1129 (0.9%); marginal OR 1.99; 95% CI 1.12 to 3.53; p=0.021) and higher survival to discharge (25/370 (6.8%) vs 63/1154 (5.5%); marginal OR 1.43; 95% CI 1.08 to 1.90; p=0.012). However, no association with signs of life on hospital arrival was observed (65/341 (19.1%) vs 147/1026 (14.3%); marginal OR 1.09; 95% CI 0.89 to 1.34). Favourable outcomes were observed only in patients who underwent intubation with a severe chest injury (Abbreviated Injury Score ≥3) and with transportation time to hospital >15 min (OR 14.44 and 2.00; 95% CI 1.89 to 110.02 and 1.09 to 3.65, respectively).

Conclusions Prehospital intubation was associated with favourable neurological outcomes among adult patients with t-OHCA who had severe chest injury or transportation time >15 min.

  • trauma
  • airway
  • pre-hospital care

Data availability statement

Data are available upon reasonable request. The data used in this study are available from the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine. However, restrictions apply to the availability of these data, which were used under licence for this study and are not publicly available. However, data are available upon reasonable request to the corresponding author (RY) and with permission of the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine.

https://doi.org/10.1136/emermed-2024-214337

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    Data availability statement

    Data are available upon reasonable request. The data used in this study are available from the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine. However, restrictions apply to the availability of these data, which were used under licence for this study and are not publicly available. However, data are available upon reasonable request to the corresponding author (RY) and with permission of the Japanese Association for Trauma Surgery and the Japanese Association for Acute Medicine.

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    Footnotes

    • Handling editor Jason E Smith

    • Contributors RY and MS designed the study. RY performed data collection. MS and JS managed quality control. RY, MS and RT performed data analysis, interpretation, writing and critical revision. All authors have revised the manuscript. RY is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.