dr-exmedic.com

Studies have tried very hard to find a correlation between prehospital intubation and mortality rates, and few have found anything remotely positive to say about prehospital ETI–though there are plenty of studies suggesting no difference, and plenty suggesting harm. It’s hard to say that those suggesting harm are 100% accurate, though, since many have used hospital data to identify research subjects rather than the EMS tripsheets.

That’s why a more recent study is so interesting: the ROC Group studied a group of patients based solely on medic-documented GCS of 8 or less in the field. Interestingly, the intubation attempt rate was pretty close to 50% (758 patients had an attempt and 797 didn’t). Patients with an intubation attempt did worse, with a mortality rate of 57.3%, compared to the 33.6% of those with no attempt. However, those with an intubation attempt were almost twice as likely to have had hypotension, were more likely to have penetrating trauma, and had an average GCS 1 point lower, so it’s not surprising that they died at a higher rate. Less surprisingly, those intubated patients who died had worse BP and GCS numbers than the intubated patients who didn’t die.

That’s not a surprising or even unusual finding. What’s next is.

The group also found that the sites in the ROC consortium with the highest intubation rates had a trend towards having the lowest mortality, both total and among those with an intubation attempt. Let me steal the raw table (with a bit of cropping and cutting out boring columns, click to enlarge):

Doesn’t look like much, does it? Let’s show it another way:

It suddenly jumps out a bit more, doesn’t it? Granted, the actual study used statistics to determine that there was indeed a significant trend, but this is a bit easier to see. It’s also a tremendously interesting finding, and is similar to what I’ve felt about prehospital ETI for the last couple of years: it’s not that prehospital ETI is dangerous for patients, it’s that prehospital ETI as it is currently practiced in many places is dangerous for patients.