A Comparison of Combat Casualty Outcomes after Prehospital Versus Military Treatment Facility Airway Management.

Background: Airway obstruction is the second leading cause of potentially survivable death on the battlefield. Previous studies demonstrate casualties undergoing airway interventions have worse outcomes when the procedure occurs in the prehospital setting versus the military treatment facility (MTF) setting. We compare outcomes between casualties undergoing airway management in these 2 settings using the Department of Defense Trauma Registry (DODTR).

Methods: This is a secondary analysis of a previously described dataset from the DODTR. We included US military casualties with at least 24 hours on the ventilator. We compared casualties who underwent intubation in the prehospital setting versus hospital setting. Multivariable logistic regression models were constructed to adjust for available confounders.

Results: There were 2,124 that met inclusion for this analysis-278 in the prehospital cohort and 1,846 in the MTF cohort. Median injury severity scores were higher in the prehospital cohort (25 versus 22, p is less than 0.001). The survival to discharge was lower in the prehospital cohort (80% versus 93%, p is less than 0.001). On multivariable logistic regression model, when adjusting for injury severity score, mechanism of injury, and first 24-hour blood products, the odds of survival were 0.34 (95% CI 0.23-0.50) for those intubated prehospital versus MTF.

Conclusions: We found worse survival for those with prehospital airway intervention versus those in the MTFsetting. These findings persisted after adjustment for measurable confounders. Our findings suggest prehospital-focused improvements in airway interventions are needed and/or robust methods for rapid evacuation to an MTF for airway intervention.