Effect of pre-hospital advanced life support with rapid sequence intubation on outcome of severe traumatic brain injury

Background: The role of pre‐hospital trauma care and the effect of pre‐hospital rapid sequence intubation (RSI) on patient outcome are still not clear. This study evaluated the impact of pre‐hospital trauma care by emergency physicians (EP) on mortality from severe traumatic brain injury (TBI) and a 180‐day Glasgow Outcome Scale (GOS). Methods: A 48‐month parallel non‐controlled cohort study compared a group of 64 patients with severe TBI [Glasgow Coma Scale (GCS) < 9; Injury Severity Score (ISS) > 15] who received pre‐hospital advanced life support (ALS) with RSI and were transported to the hospital by EPs (EP group), with a group of 60 patients who did not receive pre‐hospital ALS with RSI [emergency medical technicians (EMT) group]. Results: There were no significant statistical differences between the groups in age (P= 0.79), mechanism of injury (P= 0.68), gender (P= 0.82), initial GCS (P= 0.63), initial SaO2 in the field (P= 0.63), initial systolic blood pressure in the field (P= 0.47) and on‐scene time (P= 0.41). In the EP group, there was significantly better first hour survival (97% vs. 79%, P= 0.02), first day survival (90% vs. 72%, P= 0.02), better functional outcome (GOS 4–5: 53% vs. 33%, P < 0.01; GOS 2–3: 8% vs. 20%, P < 0.01) and shortened hospitalization time in intensive care unit (ICU) (P= 0.03) and other departments (P= 0.04). In total hospital mortality, we detected no differences between both groups [EP group: 40% (95% CI: 34–45%) vs. EMT group 42% (95% CI: 36–47%, P= 0.76], except in a subgroup of patients with GCS 6–8 where there was significantly lower total hospital mortality in the EP group (24% vs. 78%, P < 0.01). Conclusion: After starting the trauma care system with emergency physicians in our region, there was a decrease in the number of deaths on hospital admission, a reduction in hospital mortality in the GCS group 6–8, a change in the temporal distribution of deaths, an improvement in functional neurological outcome and shortened hospitalization time.