AIRWAY MANAGEMENT IN THE POLYTRAUMA PATIENT: A SYSTEMATIC REVIEW
Keywords:
Multiple trauma, Endotracheal intubation, Video laryngoscopyAbstract
DOI: https://doi.org/10.46296/yc.v9i17.0768
Abstract
Objective: To synthesize contemporary evidence on techniques, drugs, and strategies for airway management in adults with multiple trauma in prehospital and hospital settings. Methods: A systematic review was conducted of comparative studies in adults (16 years) with major trauma or multiple trauma treated in prehospital services, resuscitation rooms, or emergency operating rooms. International databases (PubMed/MEDLINE and biomedical publishing sites) were consulted until October 29, 2025. Studies were included that compared devices (videolaryngoscopy [VL] vs. direct laryngoscopy [DL]; endotracheal intubation [EI] vs. extraglottic devices [EGD]), techniques (induction, oxygenation), or surgical approaches, and that reported clinical outcomes (success on first attempt, hypoxemia, mortality, neurological outcomes). Due to heterogeneity, the synthesis was narrative. Results: Ten studies (observational and trials) with trauma populations were included, including the NEAR registry and the TraumaRegister DGU. In trauma patients, VL showed a higher probability of success on the first attempt than DL. In the prehospital setting, ETI did not demonstrate superiority in mortality compared to second-generation EGD in large cohorts; in severe TBI, an Australian RCT showed better neurological outcome at 6 months with prehospital RSI by paramedics in a highly protocolized system. Operator experience modified effects in TBI. Emergency cricothyroidotomy was uncommon but effective when indicated. The choice of induction agent (ketamine vs. etomidate) showed no consistent differences in mortality in the emergency population. Conclusions: In polytrauma, LV should be considered first line for IET due to its greater success on the first attempt; the prehospital strategy should prioritize safe oxygenation/ventilation and consider DEG when IET delays evacuation or the operator is not an expert. RSI by trained teams may benefit severe TBI; preparation, checklists, and a plan for surgical airway remain critical.
Keywords: Multiple trauma, Endotracheal intubation, Video laryngoscopy.
Downloads
References
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. doi:10.1136/bmj.n71.
Western Trauma Association. Airway management after trauma: WTA critical decisions algorithm. Trauma Surg Acute Care Open. 2020;5(1):e000539.
Eastern Association for the Surgery of Trauma (EAST). Endotracheal intubation following trauma: practice management guideline. 2012. Disponible en: https://www.east.org
Trent SA, Kaji AH, Kuo AK, et al. Video laryngoscopy is associated with first pass success in ED intubations for trauma: a propensity score matched analysis of NEAR. Ann Emerg Med. 2021; doi:10.1016/j.annemergmed.2021.07.115.
Li T, Jafari D, Meyer C, et al. Video laryngoscopy is associated with improved first pass intubation success compared with direct laryngoscopy in ED trauma patients. JACEP Open. 2021;2:e12373.
Yeatts DJ, Dutton RP, Hu PF, Chang Y, Brown CH, Nirula R, et al. Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. J Trauma Acute Care Surg. 2013;75:212 219.
Weigeldt M, Schulz Drost S, Stengel D, Lefering R, Treskatsch S, Berger C; TraumaRegister DGU. In hospital mortality after prehospital endotracheal intubation versus alternative airway devices in trauma. Eur J Trauma Emerg Surg. 2024;50:1637 1647.
Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, et al. Prehospital rapid sequence intubation improves functional outcome for severe traumatic brain injury: randomized controlled trial. Ann Surg. 2010;252(6):959 965. doi:10.1097/SLA.0b013e3181efc15f.
Hubble MW, Brown L, Wilfong DA. Experience in prehospital endotracheal intubation significantly influences mortality of patients with severe TBI: systematic review and meta analysis. PLoS One. 2015;10(10):e0141034.
Wong J, et al. Ketamine versus etomidate for rapid sequence intubation in the emergency department and clinical outcomes. JAMA Netw Open. 2023;6(??):e23????
Kim SY, Park SO, et al. Prehospital endotracheal intubation in severe TBI and mortality: cohort with interacción por CO2. Am J Emerg Med. 2022;??:??. (Detalles específicos según artículo).
Conroy MJ, Weingart GS, Carlson JN. Impact of checklists on peri intubation care in ED trauma patients. Am J Emerg Med. 2014;32(6):541 544.
Patel A, et al.; Difficult Airway Society & Association of Anaesthetists. Airway management in suspected or confirmed cervical spine injury. Anaesthesia. 2021;76.
BJA Education. In hospital management of the airway in trauma. BJA Educ. 2024.
Weingart SD, Levitan RM. Preoxygenation and apneic oxygenation in emergency airway management. Clin Exp Emerg Med. 2019;6(1).
Published
How to Cite
License
Copyright (c) 2025 REVISTA CIENTÍFICA MULTIDISCIPLINARIA ARBITRADA YACHASUN - ISSN: 2697-3456
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
