Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: A 9-year observational study

Stefan Heschl; Ben Meadley; Emily Andrew; Warwick Butt; Stephen Bernard; Karen Smith

doi:10.1016/j.injury.2018.02.013

Efficacy of pre-hospital rapid sequence intubation in paediatric traumatic brain injury: A 9-year observational study

Injury. 2018 May;49(5):916-920. doi: 10.1016/j.injury.2018.02.013. Epub 2018 Feb 12.

Authors

Stefan Heschl¹, Ben Meadley², Emily Andrew², Warwick Butt³, Stephen Bernard⁴, Karen Smith⁵

Affiliations

¹ Medical University of Graz, Graz, Austria; Ambulance Victoria, Melbourne, Victoria, Australia. Electronic address: stefan.heschl@medunigraz.at.
² Ambulance Victoria, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
³ The Royal Children's Hospital, Melbourne, Victoria, Australia.
⁴ Ambulance Victoria, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Intensive Care Unit, Alfred Hospital, Melbourne, Victoria, Australia.
⁵ Ambulance Victoria, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia.

PMID: 29452732
DOI: 10.1016/j.injury.2018.02.013

Abstract

Introduction: Prehospital airway management of the paediatric patient with traumatic brain injury (TBI) is controversial. Endotracheal intubation of children in the field requires specific skills and has potential benefits but also carries potentially serious complications. We aimed to compare mortality and functional outcomes after six months between children with TBI who either underwent prehospital rapid sequence intubation (RSI) by trained Intensive Care paramedics (ICP) or received no intubation.

Methods: We conducted a retrospective study of patients aged ≤14 years with suspected TBI in Victoria, Australia. Patients were either transported via helicopter and received RSI by an ICP (2005-2013) or via road ambulance and received no intubation (2006-2013). Prehospital data was linked to hospital and 6-month follow-up data to assess mortality and functional outcome.

Results: A total of 106 patients were included in the study of which 87 received RSI by paramedics and 19 did not receive intubation. Overall, the intubation success rate was 99% (86/87), with a first-pass success rate of 93% (81/87). In total, 67% of patients (n = 41) receiving RSI had a favourable functional outcome, compared with 54% of non-intubated patients (n = 7) (p = 0.36). In the 75 children with major trauma, prehospital RSI was associated with a significant decrease in length of hospital stay (523 h vs. 1939 h, p = 0.03). In the 53 children in this subgroup with available six months data the difference in favourable functional outcome increased to 66% (n = 31)vs. 17% (n = 1) (p = 0.06).

Discussion: Prehospital RSI in paediatric patients with TBI can safely be performed by highly trained paramedics. Overall, we observed more favourable long-term outcomes in patients who received prehospital intubation than those who did not, however our study is not powered to detect a significant difference. Intubation prior to transport might be beneficial for major trauma patients.

Keywords: Endotracheal intubation; Paediatrics; Paramedic; Traumatic brain injury.

Publication types

Comparative Study
Observational Study

MeSH terms

Adolescent
Airway Management* / standards
Allied Health Personnel* / organization & administration
Allied Health Personnel* / standards
Brain Injuries, Traumatic / mortality
Brain Injuries, Traumatic / physiopathology
Brain Injuries, Traumatic / therapy*
Child
Child, Preschool
Clinical Competence / standards*
Efficiency, Organizational
Female
Follow-Up Studies
Hospital Mortality
Humans
Infant
Intubation, Intratracheal* / standards
Length of Stay / statistics & numerical data*
Male
Retrospective Studies
Survival Rate
Treatment Outcome
Victoria