Severe traumatic brain injury (TBI) is a leading cause of death in young adults, and survivors are frequently left with long-term disabilities. Prehospital TBI management focuses on improving these outcomes by preventing secondary injury effects, particularly physiological disturbances. Many cases of prehospital TBI management involve tracheal intubation, a medical procedure in which a physician inserts a thin tube into a patient’s airway to ensure that the patient takes in sufficient oxygen. However, previous research has produced conflicting results regarding the benefit of pre-hospital intubation for severe TBI. This creates challenges for clinicians, as differing guidelines may cause confusion or inaction during a TBI emergency.
To address this lack of consensus in prehospital TBI care, a team of researchers conducted a review of literature in order to determine the effect of prehospital intubation on both morbidity and mortality in cases of severe TBI. The researchers analyzed 19 studies comparing patients with prehospital intubation and without prehospital intubation in patients with severe TBI. Although there was no significant difference in mortality between those who were intubated prior to hospitalization or not—those who had not been intubated had slightly favorable outcomes. Conversely, prehospital intubation showed slightly better outcomes with respect to long-term morbidity.
While these results may suggest that prehospital intubation is associated with higher mortality, a probable reason is that patients who require prehospital intubation are more likely to have experienced more severe injuries, increasing their chances of mortality regardless of intubation. Although there are risks associated with prehospital intubation, the better outcome for long-term morbidity suggests that intubated patients may live with fewer burdens on quality of life after their recovery. Ultimately, this study suggests that prehospital intubation is beneficial for patients with severe TBI, given that it is properly performed by well-trained clinicians under current TBI guidelines. In the evolving field of TBI management, it is critical for prehospital medical care providers to remain aware of current, evidence-based protocols for severe TBI.
Anderson J, Ebeid A, Stallwood-Hall C. Pre-hospital tracheal intubation in severe traumatic brain injury: a systematic review and meta-analysis. British Journal of Anesthesia. (September 2022).