Field intubation in civilian patients with hemorrhagic shock is associated with higher mortality
Abstract
Background Field intubation (FI) by emergency medical service personnel on severely injured trauma patients remains a contentious practice. Clinical studies suggest an association between FI and adverse outcomes in patients with traumatic brain injury. Military tactical emergency casualty care recommends deferring intubation and providing supplemental oxygenation until reaching a more equipped destination. In addition, animal models with penetrating hemorrhagic shock demonstrate increased acidosis with intubation before resuscitation. The purpose of this study was to evaluate the impact of FI on outcomes in trauma patients with hemorrhagic shock requiring massive transfusion. Methods The Los Angeles County Trauma System Database was retrospectively queried for all trauma patients 16 years or older with hemorrhagic shock requiring massive transfusion (≥6 U packed red blood cells in the first 24 hours) between January 1, 2012, and June 30, 2014. Demographics, clinical and transfusion data, and outcomes were compared between patients who received FI and those who did not (NO-FI). Multivariate regression analysis was used to adjust for confounders. Results Of 552 trauma patients meeting inclusion criteria, 63 (11%) received FI, and the remaining 489 (89%) were NO-FI. Age, sex, and incidence of blunt injury were similar between the FI and the NO-FI group. The FI cohort presented with a lower median Glasgow Coma Scale (GCS) score (3 vs. 14, p Conclusion FI may be associated with hi…
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The combination of hypoxemia and hypotension is additive, with an adjusted odds of death double that of the increased mortality associated with either event alone.
“The combination of hypoxemia and hypotension is additive, with an adjusted odds of death double that of the increased mortality associated with either event alone.23,97,98”
From Airway Management in Trauma (2018) · cites this paper as [98]
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Kovacs, G., & Sowers, N. (2018) · Emergency Medicine Clinics of North America · doi:10.1016/j.emc.2017.08.006 · Cited by 115 · see citing works
- Authors
- Chou, D., Harada, M. Y., Barmparas, G., Ko, A., Ley, E. J., Margulies, D. R., & Alban, R. F.
- Affiliations
- Cedars-Sinai Medical Center (US)
- Venue
- Journal of Trauma and Acute Care Surgery
- Published
- 2016-02
- Volume
- 80
- Issue
- 2
- Pages
- 278-282
- ISSN
- 2163-0755 (ISSN-L)
- OpenAlex
- W2411115539
- Cited by
- 30
- References
- 0
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 5 · 2022: 4 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 3
- FWCI
- 2.71
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Trauma: Injury, Infection, and Critical Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Cedars-Sinai Medical Center
- Topics
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Keywords
- hemorrhagic shock, massive transfusion, trauma patients, mortality, emergency medical services, prehospital care, trauma outcomes, penetrating trauma, acidosis, resuscitation timing, Injury Severity Score, Glasgow Coma Scale, trauma registry data
- MeSH terms
- Adolescent, Adult, Aged, Blood Transfusion, Emergency Medical Services, Female, Humans, Intubation, Intratracheal, Male, Middle Aged, Retrospective Studies, Shock, Hemorrhagic, Wounds and Injuries, Glasgow Coma Scale, Injury Severity Score, Treatment Outcome, Young Adult
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