The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury

Eileen M. Bulger, Michael K. Copass, Daniel R. Sabath, Ronald V. Maier, Gregory Jurkovich, Christopher C. Baker, Frederick A. Moore, Ian Black, Daniel Davis

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Background: Several studies have demonstrated that the success rate of prehospital intubation is improved by the use of neuromuscular blocking agents (NMBAs). However, a recent study has reported that prehospital intubation with NMBAs worsens outcome after traumatic brain injury (TBI). We sought to determine the effect of the use of NMBAs to facilitate prehospital intubation on outcome after TBI. Methods: All patients admitted to our Level I trauma center with a head Abbreviated Injury Scale score ≥ 3 were identified by the trauma registry (January 1998-June 2003). Patient records were matched with prehospital databases. Patients were further stratified on the basis of prehospital Glasgow Coma Scale (GCS) score into mild (GCS score of 14/15), moderate (GCS score of 9-13), and severe (GCS score < 9) TBI. Outcome included mortality and good outcome (survival to discharge with a GCS score of 14/15). Results: There were 3,052 patients who were identified as having been transported directly from the field. Complete prehospital data were available for 2,012 patients (66%). Of these, 920 were mild TBI (intubation rate, 17.4%), 293 moderate TBI (intubation rate, 57.7%), and 799 severe TBI (intubation rate, 95%). Overall, 72% of intubated patients received NMBAs. There were no significant differences in demographics or injury severity between the groups. Patients not receiving NMBAs were more likely to be hypotensive and have prehospital cardiopulmonary resuscitation (p = 0.001). The unadjusted mortality for the patients intubated with NMBAs was 25% versus 37% for those not receiving NMBAs (p < 0.001). When adjusted for confounding variables, patients intubated with NMBAs were more likely to survive (odds ratio, 0.63; 95% confidence interval, 0.41-0.97; p = 0.04) and have a good outcome (odds ratio, 1.7; 95% confidence interval, 1.2-2.6; p = 0.006) than those in the no-NMBA group. Conclusion: The use of NMBAs to facilitate prehospital intubation improves outcome for patients with TBI. The value of prehospital intubation for TBI remains to be determined; however, any trial evaluating nonintubation for TBI must be compared with NMBA-facilitated intubation to be valid.

Original languageEnglish (US)
Pages (from-to)718-724
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume58
Issue number4
DOIs
StatePublished - Apr 1 2005
Externally publishedYes

Fingerprint

Neuromuscular Blocking Agents
Intubation
Glasgow Coma Scale
Traumatic Brain Injury
Odds Ratio
Brain Concussion
Abbreviated Injury Scale
Confidence Intervals
Confounding Factors (Epidemiology)
Mortality
Trauma Centers
Cardiopulmonary Resuscitation
Wounds and Injuries
Craniocerebral Trauma
Registries

Keywords

  • Endotracheal intubation
  • Neuromuscular blocking agents
  • Paralytics
  • Prehospital

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury. / Bulger, Eileen M.; Copass, Michael K.; Sabath, Daniel R.; Maier, Ronald V.; Jurkovich, Gregory; Baker, Christopher C.; Moore, Frederick A.; Black, Ian; Davis, Daniel.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 58, No. 4, 01.04.2005, p. 718-724.

Research output: Contribution to journalArticle

Bulger, Eileen M. ; Copass, Michael K. ; Sabath, Daniel R. ; Maier, Ronald V. ; Jurkovich, Gregory ; Baker, Christopher C. ; Moore, Frederick A. ; Black, Ian ; Davis, Daniel. / The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 58, No. 4. pp. 718-724.
@article{bb39f9f6c28c419eb1e17b21f1400c36,
title = "The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury",
abstract = "Background: Several studies have demonstrated that the success rate of prehospital intubation is improved by the use of neuromuscular blocking agents (NMBAs). However, a recent study has reported that prehospital intubation with NMBAs worsens outcome after traumatic brain injury (TBI). We sought to determine the effect of the use of NMBAs to facilitate prehospital intubation on outcome after TBI. Methods: All patients admitted to our Level I trauma center with a head Abbreviated Injury Scale score ≥ 3 were identified by the trauma registry (January 1998-June 2003). Patient records were matched with prehospital databases. Patients were further stratified on the basis of prehospital Glasgow Coma Scale (GCS) score into mild (GCS score of 14/15), moderate (GCS score of 9-13), and severe (GCS score < 9) TBI. Outcome included mortality and good outcome (survival to discharge with a GCS score of 14/15). Results: There were 3,052 patients who were identified as having been transported directly from the field. Complete prehospital data were available for 2,012 patients (66{\%}). Of these, 920 were mild TBI (intubation rate, 17.4{\%}), 293 moderate TBI (intubation rate, 57.7{\%}), and 799 severe TBI (intubation rate, 95{\%}). Overall, 72{\%} of intubated patients received NMBAs. There were no significant differences in demographics or injury severity between the groups. Patients not receiving NMBAs were more likely to be hypotensive and have prehospital cardiopulmonary resuscitation (p = 0.001). The unadjusted mortality for the patients intubated with NMBAs was 25{\%} versus 37{\%} for those not receiving NMBAs (p < 0.001). When adjusted for confounding variables, patients intubated with NMBAs were more likely to survive (odds ratio, 0.63; 95{\%} confidence interval, 0.41-0.97; p = 0.04) and have a good outcome (odds ratio, 1.7; 95{\%} confidence interval, 1.2-2.6; p = 0.006) than those in the no-NMBA group. Conclusion: The use of NMBAs to facilitate prehospital intubation improves outcome for patients with TBI. The value of prehospital intubation for TBI remains to be determined; however, any trial evaluating nonintubation for TBI must be compared with NMBA-facilitated intubation to be valid.",
keywords = "Endotracheal intubation, Neuromuscular blocking agents, Paralytics, Prehospital",
author = "Bulger, {Eileen M.} and Copass, {Michael K.} and Sabath, {Daniel R.} and Maier, {Ronald V.} and Gregory Jurkovich and Baker, {Christopher C.} and Moore, {Frederick A.} and Ian Black and Daniel Davis",
year = "2005",
month = "4",
day = "1",
doi = "10.1097/01.TA.0000159239.14181.BC",
language = "English (US)",
volume = "58",
pages = "718--724",
journal = "Journal of Trauma and Acute Care Surgery",
issn = "2163-0755",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

TY - JOUR

T1 - The use of neuromuscular blocking agents to facilitate prehospital intubation does not impair outcome after traumatic brain injury

AU - Bulger, Eileen M.

AU - Copass, Michael K.

AU - Sabath, Daniel R.

AU - Maier, Ronald V.

AU - Jurkovich, Gregory

AU - Baker, Christopher C.

AU - Moore, Frederick A.

AU - Black, Ian

AU - Davis, Daniel

PY - 2005/4/1

Y1 - 2005/4/1

N2 - Background: Several studies have demonstrated that the success rate of prehospital intubation is improved by the use of neuromuscular blocking agents (NMBAs). However, a recent study has reported that prehospital intubation with NMBAs worsens outcome after traumatic brain injury (TBI). We sought to determine the effect of the use of NMBAs to facilitate prehospital intubation on outcome after TBI. Methods: All patients admitted to our Level I trauma center with a head Abbreviated Injury Scale score ≥ 3 were identified by the trauma registry (January 1998-June 2003). Patient records were matched with prehospital databases. Patients were further stratified on the basis of prehospital Glasgow Coma Scale (GCS) score into mild (GCS score of 14/15), moderate (GCS score of 9-13), and severe (GCS score < 9) TBI. Outcome included mortality and good outcome (survival to discharge with a GCS score of 14/15). Results: There were 3,052 patients who were identified as having been transported directly from the field. Complete prehospital data were available for 2,012 patients (66%). Of these, 920 were mild TBI (intubation rate, 17.4%), 293 moderate TBI (intubation rate, 57.7%), and 799 severe TBI (intubation rate, 95%). Overall, 72% of intubated patients received NMBAs. There were no significant differences in demographics or injury severity between the groups. Patients not receiving NMBAs were more likely to be hypotensive and have prehospital cardiopulmonary resuscitation (p = 0.001). The unadjusted mortality for the patients intubated with NMBAs was 25% versus 37% for those not receiving NMBAs (p < 0.001). When adjusted for confounding variables, patients intubated with NMBAs were more likely to survive (odds ratio, 0.63; 95% confidence interval, 0.41-0.97; p = 0.04) and have a good outcome (odds ratio, 1.7; 95% confidence interval, 1.2-2.6; p = 0.006) than those in the no-NMBA group. Conclusion: The use of NMBAs to facilitate prehospital intubation improves outcome for patients with TBI. The value of prehospital intubation for TBI remains to be determined; however, any trial evaluating nonintubation for TBI must be compared with NMBA-facilitated intubation to be valid.

AB - Background: Several studies have demonstrated that the success rate of prehospital intubation is improved by the use of neuromuscular blocking agents (NMBAs). However, a recent study has reported that prehospital intubation with NMBAs worsens outcome after traumatic brain injury (TBI). We sought to determine the effect of the use of NMBAs to facilitate prehospital intubation on outcome after TBI. Methods: All patients admitted to our Level I trauma center with a head Abbreviated Injury Scale score ≥ 3 were identified by the trauma registry (January 1998-June 2003). Patient records were matched with prehospital databases. Patients were further stratified on the basis of prehospital Glasgow Coma Scale (GCS) score into mild (GCS score of 14/15), moderate (GCS score of 9-13), and severe (GCS score < 9) TBI. Outcome included mortality and good outcome (survival to discharge with a GCS score of 14/15). Results: There were 3,052 patients who were identified as having been transported directly from the field. Complete prehospital data were available for 2,012 patients (66%). Of these, 920 were mild TBI (intubation rate, 17.4%), 293 moderate TBI (intubation rate, 57.7%), and 799 severe TBI (intubation rate, 95%). Overall, 72% of intubated patients received NMBAs. There were no significant differences in demographics or injury severity between the groups. Patients not receiving NMBAs were more likely to be hypotensive and have prehospital cardiopulmonary resuscitation (p = 0.001). The unadjusted mortality for the patients intubated with NMBAs was 25% versus 37% for those not receiving NMBAs (p < 0.001). When adjusted for confounding variables, patients intubated with NMBAs were more likely to survive (odds ratio, 0.63; 95% confidence interval, 0.41-0.97; p = 0.04) and have a good outcome (odds ratio, 1.7; 95% confidence interval, 1.2-2.6; p = 0.006) than those in the no-NMBA group. Conclusion: The use of NMBAs to facilitate prehospital intubation improves outcome for patients with TBI. The value of prehospital intubation for TBI remains to be determined; however, any trial evaluating nonintubation for TBI must be compared with NMBA-facilitated intubation to be valid.

KW - Endotracheal intubation

KW - Neuromuscular blocking agents

KW - Paralytics

KW - Prehospital

UR - http://www.scopus.com/inward/record.url?scp=17844401509&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=17844401509&partnerID=8YFLogxK

U2 - 10.1097/01.TA.0000159239.14181.BC

DO - 10.1097/01.TA.0000159239.14181.BC

M3 - Article

C2 - 15824647

AN - SCOPUS:17844401509

VL - 58

SP - 718

EP - 724

JO - Journal of Trauma and Acute Care Surgery

JF - Journal of Trauma and Acute Care Surgery

SN - 2163-0755

IS - 4

ER -