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Aug 29, 2013Article Details
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Main Article Content
Outcomes following prehospital airway management in severe traumatic brain injury
Abstract
Objective. To describe the outcome of TBI with various airway management methods employed in the prehospital setting in the Cape Town Metropole.
Methods. The study was a cohort descriptive observational analysis of 124 consecutively injured adult patients who were admitted for severe TBI (Glasgow Coma Score .8) to Groote Schuur and Tygerberg hospitals between 1 January 2009 and 31 August 2011. Patients were categorised by their method of airway management: rapid sequence intubation (RSI), sedation-assisted intubation, failed intubation, basic airway management, and intubated without drugs. Good outcomes were defined by a Glasgow Outcome Score of 4 - 5.
Results. There was a statistically significant association between airway management and outcome (p=0.013). Patients who underwent basic airway management had a higher proportion of a good outcome (72.9%) than patients who were intubated in the prehospital setting. A good outcome was observed with 61.8% and 38.4% of patients who experienced sedation-assisted intubation and RSI, respectively. Patients intubated
without drugs had the poorest outcome (88%), followed by rapid sequence intubation (61.5%) and by the sedation assisted group (38.2%). Conclusion. Prehospital intubation did not demonstrate improved outcomes over basic airway management in patients with severe TBI. A
large prospective, randomised trial is warranted to yield some insight into how these airway interventions influence outcome in severe TBI.
