Scientific Assembly, Frequency and Variability of Advanced Airway Management in Trauma: The Resuscitation Outcomes Consortium (ROC) Epistry

Mohamud R. Daya, Oregon Health & Science University
Kent M. Koprowicz, University of Washington
Aaron Monnig
Dana Zive, Oregon Health & Science University
Gena K. Sears, University of Washington
Henry Wang
Craig Newgard
Jeffrey Kerby

Abstract

Purpose: Prehospital airway management is believed to play a critical role in trauma. The purpose of this analysis is to describe the variation in the type and frequency of advanced airway methods within the Resuscitation Outcomes Consortium (ROC) Epistry, a prospective population-based registry of prehospital and hospital trauma data from 11 sites in North America. Methods: Prehospital data and outcomes were collected on all patients who suffered blunt, penetrating or burn injury with any one or more of: a) GCS<12; b) BP<90; c) respirations <10 or >29/minute; or d) an advanced airway. Data from all cases between 12/1/05 and 11/30/06 from 10 of the 11 ROC sites were included in this analysis. Advanced airways were limited to attempted oral endotracheal (ETI) or nasotracheal intubation (NTI), supraglottic airway (SGA), and cricothyrotomy. The advanced airways attempted were not considered to be mutually exclusive. Statistical analysis was performed using counts and percentages for airway methods by site with p-values from chi-square tests of heterogeneity. Results: Data from 5,788 patients were analyzed. Overall, 1267 (22%) patients received at least one prehospital advanced airway attempt, with an inter-site (Table) range of 7-49% (p<0.0001). The most common advanced airway attempted was ETI, which was used in 1174 (93%) cases. The use of NTI and SGA was unevenly distributed (p < 0.0001) and accounted for 48 (4%) and 75 (6%) of cases respectively. Two sites accounted for 63% of documented NTI attempts while two other sites accounted for 51% of SGA attempts. Half of the six cricothyroidotomies were performed by one site. Conclusion: There is substantial cross-site variation in advanced airway use for major trauma. ETI is most commonly reported. Other methods are far less common and unevenly distributed between sites; cricothyrotomy is rare. Overall, the low proportion of trauma-associated advanced airway attempts is concerning for the maintenance and proficiency of these skills among ALS providers