Association of out-of-hospital advanced airway management with outcomes after traumatic brain injury and hemorrhagic shock in the ROC hypertonic saline trial
Open accessAbstract
Objective: Prior studies suggest adverse associations between out-of-hospital advanced airway management (AAM) and patient outcomes after major trauma. This secondary analysis of data from the Resuscitation Outcomes Consortium Hypertonic Saline Trial evaluated associations between out-of-hospital AAM and outcomes in patients suffering isolated severe traumatic brain injury (TBI) or haemorrhagic shock. Methods: This multicentre study included adults with severe TBI (GCS ≤8) or haemorrhagic shock (SBP ≤70 mm Hg, or (SBP 71–90 mm Hg and heart rate ≥108 bpm)). We compared patients receiving out-of-hospital AAM with those receiving emergency department AAM. We evaluated the associations between airway strategy and patient outcomes (28-day mortality, and 6-month poor neurologic or functional outcome) and airway strategy, adjusting for confounders. Analysis was stratified by (1) patients with isolated severe TBI and (2) patients with haemorrhagic shock with or without severe TBI. Results: Of 2135 patients, we studied 1116 TBI and 528 shock; excluding 491 who died in the field, did not receive AAM or had missing data. In the shock cohort, out-of-hospital AAM was associated with increased 28-day mortality (adjusted OR 5.14; 95% CI 2.42 to 10.90). In TBI, out-of-hospital AAM showed a tendency towards increased 28-day mortality (adjusted OR 1.57; 95% CI 0.93 to 2.64) and 6-month poor functional outcome (1.63; 1.00 to 2.68), but these differences were not statistically significant. Out-of-hospital AAM was associated with poorer 6-month TBI neurologic outcome (1.80; 1.09 to 2.96). Conclusions: Out-of-hospital AAM was associated with increased mortality after haemorrhagic shock. The adverse association between out-of-hospital AAM and injury outcome is most pronounced in patients with haemorrhagic shock.
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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 [97]
The Results report adjusted mortality odds for out-of-hospital airway management in shock and TBI groups, not for hypoxemia and hypotension separately or together. A search of our copy for their combined effect found no comparison showing that the adjusted odds of death double relative to either event alone. Page numbers were not available in the indexed passages. (LLM, conf=0.76)
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Research works printed but not linked: 25
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Cited by
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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
- Wang, H. E., Brown, S. P., MacDonald, R. D., Dowling, S. K., Lin, S., Davis, D., Schreiber, M. A., Powell, J., van Heest, R., & Daya, M.
- Affiliations
- University of Alabama at Birmingham (US)
- University of Washington (US)
- St. Michael's Hospital (CA)
- University of Calgary (CA)
- University of California San Diego (US)
- Oregon Health & Science University (US)
- Corresponding author
- Wang, Henry E
- ORCID
- Venue
- Emergency Medicine Journal
- Publisher
- BMJ
- Published
- 2013-01-26
- Volume
- 31
- Issue
- 3
- Pages
- 186-191
- ISSN
- 1351-0622 (ISSN-L)
- 1472-0205
- 1472-0213
- PMC
- PMC3841245
- OpenAlex
- W2000656402
- Cited by
- 37
- References
- 0
- Citations by year
- 2025: 2 · 2024: 4 · 2023: 3 · 2022: 3 · 2021: 2 · 2020: 5 · 2019: 3 · 2018: 2 · 2017: 3 · 2015: 5 · 2014: 5
- FWCI
- 3.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Emergency Medicine Journal (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- National Institutes of Health (5u01hl077871-11, 5u01hl077863-11)
- Canadian Institutes of Health Research
- National Heart, Lung, and Blood Institute (5 U01 HL077863, HL077867, HL077881, U01-HL077863, U01HL077867, U01-HL077871, HL077873, U01HL077881, U01HL077887, HL077887, HL077871, U01HL077866, U01HL077873, HL077866, HL077885, HL077872, HL077908, U01HL077872, U01HL077908, U01HL077885)
- Topics
- Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Airway Management and Intubation Techniques
- Health Sciences › Medicine › Neurology › Traumatic Brain Injury and Neurovascular Disturbances
- Keywords
- traumatic brain injury, hemorrhagic shock, 28-day mortality, functional outcome, neurological outcome, emergency department airway management, Resuscitation Outcomes Consortium, hypertonic saline, severe trauma
- MeSH terms
- Adult, Brain Injuries, Emergency Medical Services, Female, Humans, Male, Middle Aged, Shock, Hemorrhagic, United States, Logistic Models, Hospital Mortality, Outcome Assessment, Health Care, After-Hours Care, Airway Management
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