Association of prehospital vs. in-hospital intubation with mortality in hemorrhagic shock after severe trauma: a propensity-matched study.

OBJECTIVE

Hemorrhagic shock after severe trauma has a high mortality rate. Intubation may increase hemodynamic failure in shocked patients. Our aim was to assess the association of intubation timing with mortality and morbidity among patients with hemorrhagic shock after severe trauma.

METHODS

This is a retrospective, multicenter study using data from the French Traumabase registry that includes severely injured trauma patients admitted to trauma centers. Patients were included if they were intubated, presented with hemorrhagic shock following severe trauma [≥four packed red blood cells (PRBCs) transfusions within the first 6 h of care], and underwent hemostasis surgery or interventional radiology procedure within 24 h of admission. Patients with severe trauma brain injury (abbreviated injury scale head ≥3) were excluded. The primary outcome was all-cause ICU mortality. Secondary outcomes were: time to hospital arrival, ICU and hospital lengths of stay, Simplified Acute Physiology Score II, prehospital norepinephrine use, and number of PRBCs transfusions within the first 24 h. Patients were categorized by intubation timing (prehospital intubation vs. in-hospital intubation) and matched by propensity score based on variables associated with the occurrence of prehospital intubation.

RESULTS

Among the 840 patients included [mean age 41 (±18), 646 (74%) male], 455 (54%) had road traffic accidents, 153 (18%) falls, and 189 (23%) penetrating trauma. The median Injury Severity Score was 22 (16-34). After propensity score matching, 454 patients (227/group) were analyzed. Twenty-three patients (10%) died in the ICU in the prehospital intubation group vs. 18 (7.9%) in in-hospital intubation group [OR 1.28, 95% CI (0.69-2.37)]. Concerning secondary outcomes, prehospital intubation was associated with a higher need for norepinephrine support [130 (57%) vs. 83 (37%); OR 2.47, 95% CI (1.64-3.72)] and a longer time to hospital arrival [median within-pair absolute difference: 15 min; 95% CI (5-27)]. There was no significant difference for other secondary outcomes.

CONCLUSION

In this cohort of patients with hemorrhagic shock after severe trauma, prehospital intubation was not associated with a change in ICU-mortality.