Impact of prehospital rapid sequence intubation and mechanical ventilation on prehospital vital signs and outcome in trauma patients

Introduction. Medications during rapid se-quence intubation (RSI) have known detri-mental side effects. Prehospital mechanical ventilation after successful endotracheal intubation also increases mortality due to hyperventilation and positive pressure ventilation. The aim of this retrospective analysis was to determine the impact of RSI on prehospital hemodynamic param-eters and prehospital ventilation status on mortality rate and functional outcome in trauma patients.

Methods. Charts of 73 trauma patients, who underwent prehospital RSI over a 12-year period, were retrospectively reviewed. Prehospital vital signs, before and after RSI, were compared. Patients were divided, according to ventilation status, into three groups based on initial PaCO2: hypocar-bic/hyperventilated (PaCO2<35mmHg), normocarbic/normoventilated (PaCO2 35-45 mmHg) and hypercarbic/hypoven-tilated (PaCO2>45mmHg).

Results. Seventy-three patients were en-rolled in the retrospective analysis. There was a significant difference in respira-tory rate (p=0.046), arterial oxygen satu-ration (p<0.001), mean arterial pressure (p<0.001) and Glasgow Coma Scale (GCS)(p<0.001) before and after RSI. GCS at dis-charge (p=0.003) and arterial oxygen satu-ration (p=0.05) were significantly higher in the normoventilated group. There was no significant difference in survival to hospi-tal discharge among compared groups. Conclusion. Our retrospective analysis suggests that prehospital RSI has no detri-mental hemodynamic side effects and that normoventilation leads to a favorable neu-rological outcome.

intubation, prehospital, me-chanical ventilation, trauma, hemodynam-ics

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