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A systematic review of the timing of intubation in patients with traumatic brain injury: pre-hospital versus in-hospital intubation

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

The objective of this systematic review was to examine current evidence on the risks versus benefit of pre-hospital intubation when compared with in-hospital intubation in adult patients with traumatic brain injuries.

Methods

We conducted electronic searches of PubMed, Medline, Embase, CIANHL and the Cochrane library up to March 2021. Data extracted compared mortality, length of hospital and intensive care stay, pneumonia and functional outcomes in traumatic brain injured patients undergoing pre-hospital intubation versus in-hospital intubation. The risk of bias was assessed using the Grading of Recommendations Assessment, Development and Evaluation.

Results

Ten studies including 25,766 patients were analysed. Seven were retrospective studies, two prospective cohort studies and one randomised control study. The mean mortality rate in patients who underwent pre-hospital intubation was 44.5% and 31.98% for in-hospital intubation. The odds ratio for an effect of pre-hospital intubation on mortality ranged from 0.31 (favouring in-hospital intubation) to 3.99 (favouring pre-hospital). The overall quality of evidence is low; however, the only randomised control study showed an improved functional outcome for pre-hospital intubation at 6 months.

Conclusions

The existing evidence does not support widespread pre-hospital intubation in all traumatic brain injured patients. This does not, however, contradict the need for the intervention when there is severe airway compromise; instead, it must be assessed by experienced personnel if a time critical transfer to hospital is more advantageous. Favourable neurological outcomes highlighted by the randomised control trial favours pre-hospital intubation, but further research is required in this field.

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Funding

No funding, grants, or support was received to conduct this review.

Author information

Authors and Affiliations

  1. Anaesthetic Department, The Royal London Hospital, London, E1 1FR, UK

    Archchana Radhakrishnan & Sumitra Lahiri

  2. Anaesthetic Department, Great Ormond Street Hospital, London, WC1N 3JH, UK

    Claire McCahill

  3. Anaesthetic Department, Medway Maritime Hospital, Kent, ME7 5NY, UK

    Ranjit Singh Atwal

Authors
  1. Archchana Radhakrishnan
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  2. Claire McCahill
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  3. Ranjit Singh Atwal
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  4. Sumitra Lahiri
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Correspondence to Archchana Radhakrishnan.

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Appendices

Appendix

Search strategy file 1

HDAS search

1st search

“Traumatic Brain Injury”

or

“Head Injury”

or

“Neurotrauma”

2nd search

“Pre-hospital Intubation”

or

“In-hospital intubation”

or

“Endotracheal intubation”

or

“Early intubation”

or

“Emergency intubation”

Combine search one and two

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Radhakrishnan, A., McCahill, C., Atwal, R.S. et al. A systematic review of the timing of intubation in patients with traumatic brain injury: pre-hospital versus in-hospital intubation. Eur J Trauma Emerg Surg 49, 1199–1215 (2023). https://doi.org/10.1007/s00068-022-02048-0

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  • DOI: https://doi.org/10.1007/s00068-022-02048-0

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