Value of Pre-Hospital Intubation Questioned

A study has shown that patients with similar traumatic brain injuries who receive an emergency breathing tube at the scene of an accident have worse outcomes than those who are intubated after arrival at the hospital. The findings were reported in the November 2004 issue of Annals of Emergency Medicine.

While out-of-hospital intubation can be a valuable interventional tool in helping to save lives, earlier studies had suggested that this rapid intervention may be more harmful than helpful. Now, researchers at the University of Pittsburgh (PA, USA) have conducted a retrospective analysis using data obtained from the Pennsylvania Trauma Outcome study between 2000 and 2002, and studied adult patients with severe head injuries.

The primary outcome for most of these patients was death, with secondary outcomes being various types of neurologic and functional impairment. Among the 4,098 patients who were intubated, the odds of death were about four times greater if they were intubated out of the hospital. Neurologic and functional impairment were also greater.

"Paramedics, while very well trained, don't often have opportunity to perform this procedure, and must attempt it in a difficult environment and without many of the aids available in the hospital,” said Donald M. Yealy, M.D., professor and vice chairman of the department of emergency medicine at the University of Pittsburgh School of Medicine and one of the study's authors. "Perhaps these findings indicate that we need to reassess how we manage these cases.” The researchers note that additional studies are needed.



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