TY - JOUR
T1 - Paramedic rapid sequence intubation for severe traumatic brain injury
T2 - Perspectives from an expert panel
AU - Davis, Daniel P.
AU - Fakhry, Samir M.
AU - Wang, Henry E.
AU - Bulger, Eileen M.
AU - Domeier, Robert M.
AU - Trask, Arthur L.
AU - Bochicchio, Grant V.
AU - Hauda, William E.
AU - Robinson, Linda
N1 - Funding Information:
Address correspondence and reprint requests to: Daniel Davis, MD, UCSD Emergency Medicine, 200 West Arbor Drive, #8676, San Diego, CA 92103-8676. e-mail: <[email protected]> This study was supported by the Brain Trauma Foundation through grant DTNH22-98-G-05131 from the Department of Transportation, National Highway Traffic Safety Administration.
PY - 2007/1/1
Y1 - 2007/1/1
N2 - Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice. The interpretation of this panel can be summarized as follows: (1) the existing literature regarding paramedic RSI is inconclusive, and apparent differences in outcome can be explained by use of different methodologies and variability in comparison groups; (2) the use of Glasgow Coma Scale score alone to identify TBI patients requiring RSI is limited, with additional research needed to refine our screening criteria; (3) suboptimal RSI technique as well as subsequent hyperventilation may account for some of the mortality increase reported with the procedure; (4) initial and ongoing training as well as experience with RSI appear to affect performance; and (5) the success of a paramedic RSI program is dependent on particular EMS and trauma system characteristics.
AB - Although early intubation has become standard practice in the prehospital management of severe traumatic brain injury (TBI), many patients cannot be intubated without neuromuscular blockade. Several emergency medical services (EMS) systems have implemented paramedic rapid sequence intubation (RSI) protocols, with published reports documenting apparently conflicting outcomes effects. In response, the Brain Trauma Foundation assembled a panel of experts to interpret the existing literature regarding paramedic RSI for severe TBI and offer guidance for EMS systems considering adding this skill to the paramedic scope of practice. The interpretation of this panel can be summarized as follows: (1) the existing literature regarding paramedic RSI is inconclusive, and apparent differences in outcome can be explained by use of different methodologies and variability in comparison groups; (2) the use of Glasgow Coma Scale score alone to identify TBI patients requiring RSI is limited, with additional research needed to refine our screening criteria; (3) suboptimal RSI technique as well as subsequent hyperventilation may account for some of the mortality increase reported with the procedure; (4) initial and ongoing training as well as experience with RSI appear to affect performance; and (5) the success of a paramedic RSI program is dependent on particular EMS and trauma system characteristics.
KW - Airway management
KW - Intubation
KW - Neuromuscular blockade
KW - Paramedic
KW - Prehospital
KW - Rapid sequence intubation
KW - Traumatic brain injury
UR - http://www.scopus.com/inward/record.url?scp=33845889526&partnerID=8YFLogxK
U2 - 10.1080/10903120601021093
DO - 10.1080/10903120601021093
M3 - Review article
C2 - 17169868
AN - SCOPUS:33845889526
SN - 1090-3127
VL - 11
SP - 1
EP - 8
JO - Prehospital Emergency Care
JF - Prehospital Emergency Care
IS - 1
ER -