Trauma airway management: transition from anesthesia to emergency medicine.
Trauma airway management: transition from anesthesia to emergency medicine.
- 2013
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Trauma airway management is commonly performed by either anesthesiologists or Emergency Physicians (EPs). CONCLUSIONS: EPs can safely manage the airways of trauma patients with rates of complication and failure comparable with those of anesthesiologists. Published by Elsevier Inc. METHODS: Medical records were used to identify all patients during a 3-year period who were intubated emergently after traumatic injury. Before November 1, 2007, airway management was supervised by anesthesiologists, after that date airways were supervised by EPs. Complications evaluated included failure to obtain a secure airway, multiple attempts at airway placement, new or worsening hypoxia or hypotension during the peri-intubation period, bronchial intubations, dysrhythmia, aspiration with development of infiltrate on chest x-ray study within 48 h, and facial trauma. OBJECTIVE: Our aim was to evaluate the impact of switching from one group of providers to the other, focusing on outcomes and complications. RESULTS: Of the 490 tracheal intubations, 250 were attended by EPs and 240 were attended by anesthesiologists. The groups were well matched with respect to age and sex, but the EP group treated more severely injured patients on average. Intubation was accomplished in one attempt 98.3% of the time in the anesthesia group; those requiring multiple attempts went on to need surgical airways 2.1% of the time. EPs accomplished intubation in one attempt 98.4% of the time, with an overall success rate of 96.8%; surgical airways were needed in 3.2% of patients. The complication rate was 18.3% for the anesthesia group and 18% for the EP group. There were no statistically significant differences between the EP and anesthesia groups with regard to complication rates, although the EP patients had a higher Injury Severity Score on average.
0736-4679
*Anesthesiology
*Clinical Competence
*Emergency Medicine
*Intubation, Intratracheal/sn [Statistics & Numerical Data]
*Wounds and Injuries/th [Therapy]
Adult
Female
Humans
Injury Severity Score
Intubation, Intratracheal/ae [Adverse Effects]
Intubation, Intratracheal/st [Standards]
Male
Retrospective Studies
Trauma Centers
Wounds and Injuries/ep [Epidemiology]
MedStar Washington Hospital Center
Surgery/Burn Services
Surgery/Trauma Surgery
Comparative Study
Journal Article
Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007
BACKGROUND: Trauma airway management is commonly performed by either anesthesiologists or Emergency Physicians (EPs). CONCLUSIONS: EPs can safely manage the airways of trauma patients with rates of complication and failure comparable with those of anesthesiologists. Published by Elsevier Inc. METHODS: Medical records were used to identify all patients during a 3-year period who were intubated emergently after traumatic injury. Before November 1, 2007, airway management was supervised by anesthesiologists, after that date airways were supervised by EPs. Complications evaluated included failure to obtain a secure airway, multiple attempts at airway placement, new or worsening hypoxia or hypotension during the peri-intubation period, bronchial intubations, dysrhythmia, aspiration with development of infiltrate on chest x-ray study within 48 h, and facial trauma. OBJECTIVE: Our aim was to evaluate the impact of switching from one group of providers to the other, focusing on outcomes and complications. RESULTS: Of the 490 tracheal intubations, 250 were attended by EPs and 240 were attended by anesthesiologists. The groups were well matched with respect to age and sex, but the EP group treated more severely injured patients on average. Intubation was accomplished in one attempt 98.3% of the time in the anesthesia group; those requiring multiple attempts went on to need surgical airways 2.1% of the time. EPs accomplished intubation in one attempt 98.4% of the time, with an overall success rate of 96.8%; surgical airways were needed in 3.2% of patients. The complication rate was 18.3% for the anesthesia group and 18% for the EP group. There were no statistically significant differences between the EP and anesthesia groups with regard to complication rates, although the EP patients had a higher Injury Severity Score on average.
0736-4679
*Anesthesiology
*Clinical Competence
*Emergency Medicine
*Intubation, Intratracheal/sn [Statistics & Numerical Data]
*Wounds and Injuries/th [Therapy]
Adult
Female
Humans
Injury Severity Score
Intubation, Intratracheal/ae [Adverse Effects]
Intubation, Intratracheal/st [Standards]
Male
Retrospective Studies
Trauma Centers
Wounds and Injuries/ep [Epidemiology]
MedStar Washington Hospital Center
Surgery/Burn Services
Surgery/Trauma Surgery
Comparative Study
Journal Article