Neuroanesthesia & neurocritical care
EMS Treatment Guidelines in Major Traumatic Brain Injury With Positive Pressure Ventilation
Authors' conclusion
Among patients with severe TBI who received active airway interventions in the field, guideline implementation was independently associated with improved survival to hospital admission and discharge.
Study context
- Population
- Patients with traumatic brain injury (TBI) who received prehospital positive pressure ventilation, EMS agencies across Arizona, 2007–2017of 21,852 in main study
- Participants
- 5,022 patients
- Comparison
- Preimplementation vs Postimplementation
- Preimplementationn = 3,531reference
- Postimplementationn = 1,491
- Primary endpoint
- Survival to hospital discharge
Methodological detailsprespecified (a priori) subanalysis, multisystem, intention-to-treat, before/after controlled design, stratified by TBI severity (moderate, severe, critical), Data collected January 2007 to June 2017; analysed January to February 2023
- Prespecified (a priori) subanalysis
- Multisystem
- Intention-to-treat
- Before/after controlled design
- Stratified by TBI severity (moderate, severe, critical)
- Data collected January 2007 to June 2017; analysed January to February 2023
Primary result
As reported in the abstract
Survival to discharge, all severities combined (aOR, postimplementation vs preimplementation); not improved
aOR 0.94
95% CI 0.78–1.13
Survival to discharge, severe TBI (aOR, postimplementation vs preimplementation); increased, not in moderate or critical subgroups
aOR 3.52
95% CI 1.96–6.34
Secondary outcomes
aOR
- Survival to admission, all severities combined (aOR, postimplementation vs preimplementation); improved
- 1.59 (95% CI 1.28-1.97)
- Survival to hospital admission, severe TBI (aOR, postimplementation vs preimplementation); increased, not in moderate or critical subgroups
- 6.44 (95% CI 2.39-22.00)
Original publication
EMS Treatment Guidelines in Major Traumatic Brain Injury With Positive Pressure Ventilation. JAMA Surg. Published 1 April 2024. doi:10.
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