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Meta-Analysis
. 2017 Jul 31;21(1):192.
doi: 10.1186/s13054-017-1787-x.

A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients

Espen Fevang  1   2 , Zane Perkins  3   4 , David Lockey  3   4   5 , Elisabeth Jeppesen  6   5 , Hans Morten Lossius  6   5
Affiliations
Meta-Analysis

A systematic review and meta-analysis comparing mortality in pre-hospital tracheal intubation to emergency department intubation in trauma patients

Espen Fevang et al. Crit Care. .

Abstract

Background: Pre-hospital endotracheal intubation is frequently used for trauma patients in many emergency medical systems. Despite a wide range of publications in the field, it is debated whether the intervention is associated with a favourable outcome, when compared to more conservative airway measures.

Methods: A systematic literature search was conducted to identify interventional and observational studies where the mortality rates of adult trauma patients undergoing pre-hospital endotracheal intubation were compared to those undergoing emergency department intubation.

Results: Twenty-one studies examining 35,838 patients were included. The median mortality rate in patients undergoing pre-hospital intubation was 48% (range 8-94%), compared to 29% (range 6-67%) in patients undergoing intubation in the emergency department. Odds ratios were in favour of emergency department intubation both in crude and adjusted mortality, with 2.56 (95% CI: 2.06, 3.18) and 2.59 (95% CI: 1.97, 3.39), respectively. The overall quality of evidence is very low. Twelve of the twenty-one studies found a significantly higher mortality rate after pre-hospital intubation, seven found no significant differences, one found a positive effect, and for one study an analysis of the mortality rate was beyond the scope of the article.

Conclusions: The rationale for wide and unspecific indications for pre-hospital intubation seems to lack support in the literature, despite several publications involving a relatively large number of patients. Pre-hospital intubation is a complex intervention where guidelines and research findings should be approached cautiously. The association between pre-hospital intubation and a higher mortality rate does not necessarily contradict the importance of the intervention, but it does call for a thorough investigation by clinicians and researchers into possible causes for this finding.

Keywords: Airway management; Emergency medical services; Intratracheal; Intubation; Pre-hospital; Rapid sequence induction; Trauma.

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Conflict of interest statement

Ethics approval and consent to participate

The study is a systematic review, and no ethical approval or consent was necessary.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow diagram. PHI pre-hospital intubation, EDI emergency department intubation, RSI rapid sequence induction intubation, AOR adjusted odds ratio
Fig. 2
Fig. 2
Mortality rates in pre-hospital intubation (PHI) versus emergency department intubation (EDI). RSI rapid sequence induction, M-H Mantel Haenszel
Fig. 3
Fig. 3
Adjusted odds ratios for mortality rates of pre-hospital intubation (PHI) versus emergency department intubation (EDI). RSI rapid sequence induction
See this image and copyright information in PMC

References

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