The following is a summary of “Interventions associated with survival after prehospital intubation in the deployed combat setting,” published in the May 2024 issue of Emergency Medicine by April, et al.

Airway compromise ranks as the second leading cause of potentially preventable death on the battlefield. In kinetic combat environments, prehospital airway management becomes essential, a necessity that is expected to rise in future wars where timely evacuation and air superiority are not guaranteed. For a study, researchers sought to compare the characteristics of survivors and non-survivors among combat casualties undergoing prehospital airway intubation.

They analyzed data from the Department of Defense Trauma Registry (DODTR) covering 2007 to 2023, focusing on encounters with documentation of any airway intervention or assessment within 72 hours post-injury. A retrospective cohort study was conducted on casualties with documented prehospital intubation. Descriptive and inferential statistical analyses compared survivors through 7 days post-injury versus non-survivors. Additionally, three multivariable logistic regression models were constructed to assess associations between interventions and 7-day survival, adjusting for injury severity score, mechanism of injury, and the administration of sedatives, paralytics, and blood products.

Among 48,301 patients, 1,377 had documentation of prehospital intubation in a combat setting. Of these, 1,028 (75%) survived through 7 days post-injury. A higher proportion of survivors received ketamine, paralytic agents, parenteral opioids, and parenteral benzodiazepines, while no significant difference was observed in the proportion of survivors versus non-survivors receiving etomidate. Multivariable models consistently indicated positive associations between 7-day survival and the receipt of non-depolarizing paralytics and opioid analgesics.

The findings of our study are promising, suggesting a positive association between the receipt of non-depolarizing paralytics and opioid analgesics and 7-day survival among patients undergoing prehospital intubation. However, the urgency of the situation is clear. Further research, particularly multi-center randomized controlled trials, is needed to establish optimal pharmacologic strategies for patients with trauma undergoing prehospital airway management.

Reference: sciencedirect.com/science/article/abs/pii/S0735675724000627