Definitive airway management after pre-hospital supraglottic airway insertion: Outcomes and a management algorithm for trauma patients

Background Prehospital airway management increasingly involves supraglottic airway insertion and a paucity of data evaluates outcomes in trauma populations. We aim to describe definitive airway management in traumatically injured patients who necessitated prehospital supraglottic airway insertion. Methods We performed a single institution retrospective review of multisystem injured patients (≥ 15 years) that received prehospital supraglottic airway insertion during 2009 to 2016. Baseline demographics, number and type of: supraglottic airway insertion attempts, definitive airway and complications were recorded. Primary outcome was need for tracheostomy. Univariate and multivariable statistics were performed. Results 56 patients met inclusion criteria and were reviewed, 78% were male. Median age [IQR] was 36 [24–56] years. Injuries comprised blunt (94%), penetrating (4%) and burns (2%). Median ISS was 26 [22–41]. Median number of prehospital endotracheal intubation (PETI) attempts was 2 [1-3]. Definitive airway management included: (n = 20, 36%, tracheostomy), (n = 10, 18%, direct laryngoscopy), (n = 6, 11%, bougie), (n = 9, 15%, Glidescope), (n = 11, 20%, bronchoscopic assistance). 24-hour mortality was 41%. Increasing number of PETI was associated with increasing facial injury. On regression, increasing cervical and facial injury patterns as well as number of PETI were associated with definitive airway control via surgical tracheostomy. Conclusions After supraglottic airway insertion, operative or non-operative approaches can be utilized to obtain a definitive airway. Patients with increased craniofacial injuries have an increased risk for airway complications and need for tracheostomy. We used these factors to generate an evidence based algorithm that requires prospective validation. Level of evidence Level IV – Retrospective study. Study type Retrospective single institution study.