Tracheal intubation in traumatic brain injury: a multicentre prospective observational study

Benjamin Yael Gravesteijn; Charlie Aletta Sewalt; Daan Nieboer; David Krishna Menon; Andrew Maas; Fiona Lecky; Markus Klimek; Hester Floor Lingsma; Cecilia Åkerlund; Krisztina Amrein; Nada Andelic; Lasse Andreassen; Audny Anke; Anna Antoni; Gérard Audibert; Philippe Azouvi; Maria Luisa Azzolini; Ronald Bartels; Pál Barzó; Romuald Beauvais; Ronny Beer; Bo Michael Bellander; Antonio Belli; Habib Benali; Maurizio Berardino; Luigi Beretta; Morten Blaabjerg; Peter Bragge; Alexandra Brazinova; Vibeke Brinck; Joanne Brooker; Camilla Brorsson; Andras Buki; Monika Bullinger; Manuel Cabeleira; Alessio Caccioppola; Emiliana Calappi; Maria Rosa Calvi; Peter Cameron; Guillermo Carbayo Lozano; Marco Carbonara; Simona Cavallo; Giorgio Chevallard; Arturo Chieregato; Giuseppe Citerio; Iris Ceyisakar; Hans Clusmann; Mark Coburn; Jonathan Coles; Jamie D. Cooper; Marta Correia; Amra Čović; Nicola Curry; Endre Czeiter; Marek Czosnyka; Claire Dahyot-Fizelier; Paul Dark; Helen Dawes; Véronique De Keyser; Vincent Degos; Francesco Della Corte; Hugo den Boogert; Bart Depreitere; Đula Đilvesi; Abhishek Dixit; Emma Donoghue; Jens Dreier; Guy Loup Dulière; Ari Ercole; Patrick Esser; Erzsébet Ezer; Martin Fabricius; Valery L. Feigin; Kelly Foks; Shirin Frisvold; Alex Furmanov; Pablo Gagliardo; Damien Galanaud; Dashiell Gantner; Guoyi Gao; Pradeep George; Alexandre Ghuysen; Lelde Giga; Ben Glocker; Jagoš Golubovic; Pedro A. Gomez; Johannes Gratz; Benjamin Gravesteijn; Francesca Grossi; Russell L. Gruen; Deepak Gupta; Juanita A. Haagsma; Iain Haitsma; Raimund Helbok; Eirik Helseth; Lindsay Horton; Jilske Huijben; Peter J. Hutchinson; Bram Jacobs; Stefan Jankowski; Mike Jarrett; Ji yao Jiang; Faye Johnson; Kelly Jones; Mladen Karan; Angelos G. Kolias; Erwin Kompanje; Daniel Kondziella; Evgenios Koraropoulos; Lars Owe Koskinen; Noémi Kovács; Ana Kowark; Alfonso Lagares; Linda Lanyon; Steven Laureys; Didier Ledoux; Rolf Lefering; Valerie Legrand; Aurelie Lejeune; Leon Levi; Roger Lightfoot; Andrew I.R. Maas; Ana M. Castaño-León; Marc Maegele; Marek Majdan; Alex Manara; Geoffrey Manley; Costanza Martino; Hugues Maréchal; Julia Mattern; Catherine McMahon; Béla Melegh; Tomas Menovsky; Ana Mikolic; Benoit Misset; Visakh Muraleedharan; Lynnette Murray; Ancuta Negru; David Nelson; Virginia Newcombe; József Nyirádi; Otesile Olubukola; Matej Oresic; Fabrizio Ortolano; Aarno Palotie; Paul M. Parizel; Jean François Payen; Natascha Perera; Vincent Perlbarg; Paolo Persona; Wilco Peul; Anna Piippo-Karjalainen; Matti Pirinen; Horia Ples; Suzanne Polinder; Inigo Pomposo; Jussi P. Posti; Louis Puybasset; Andreea Radoi; Arminas Ragauskas; Rahul Raj; Malinka Rambadagalla; Jonathan Rhodes; Sylvia Richardson; Sophie Richter; Samuli Ripatti; Saulius Rocka; Cecilie Roe; Olav Roise; Jonathan Rosand; Jeffrey V. Rosenfeld; Christina Rosenlund; Guy Rosenthal; Rolf Rossaint; Sandra Rossi; Daniel Rueckert; Martin Rusnák; Juan Sahuquillo; Oliver Sakowitz; Renan Sanchez-Porras; Janos Sandor; Nadine Schäfer; Silke Schmidt; Herbert Schoechl; Guus Schoonman; Rico Frederik Schou; Elisabeth Schwendenwein; Charlie Sewalt; Toril Skandsen; Peter Smielewski; Abayomi Sorinola; Emmanuel Stamatakis; Simon Stanworth; Robert Stevens; William Stewart; Ewout W. Steyerberg; Nino Stocchetti; Nina Sundström; Anneliese Synnot; Riikka Takala; Viktória Tamás; Tomas Tamosuitis; Mark Steven Taylor; Braden Te Ao; Olli Tenovuo; Alice Theadom; Matt Thomas; Dick Tibboel; Marjolein Timmers; Christos Tolias; Tony Trapani; Cristina Maria Tudora; Peter Vajkoczy; Shirley Vallance; Egils Valeinis; Zoltán Vámos; Mathieu van der Jagt; Gregory Van der Steen; Joukje van der Naalt; Jeroen T.J.M. van Dijck; Thomas A. van Essen; Wim Van Hecke; Caroline van Heugten; Dominique Van Praag; Thijs Vande Vyvere; Roel P.J. van Wijk; Alessia Vargiolu; Emmanuel Vega; Kimberley Velt; Jan Verheyden; Paul M. Vespa; Anne Vik; Rimantas Vilcinis; Victor Volovici; Nicole von Steinbüchel; Daphne Voormolen; Petar Vulekovic; Kevin K.W. Wang; Eveline Wiegers; Guy Williams; Lindsay Wilson; Stefan Winzeck; Stefan Wolf; Zhihui Yang; Peter Ylén; Alexander Younsi; Frederick A. Zeiler; Veronika Zelinkova; Agate Ziverte; Tommaso Zoerle

doi:10.1016/j.bja.2020.05.067

Tracheal intubation in traumatic brain injury: a multicentre prospective observational study

Benjamin Yael Gravesteijn, Charlie Aletta Sewalt, Daan Nieboer, David Krishna Menon, Andrew Maas, Fiona Lecky, Markus Klimek, Hester Floor Lingsma, Cecilia Åkerlund, Krisztina Amrein, Nada Andelic, Lasse Andreassen, Audny Anke, Anna Antoni, Gérard Audibert, Philippe Azouvi, Maria Luisa Azzolini, Ronald Bartels, Pál Barzó, Romuald BeauvaisRonny Beer, Bo Michael Bellander, Antonio Belli, Habib Benali, Maurizio Berardino, Luigi Beretta, Morten Blaabjerg, Peter Bragge, Alexandra Brazinova, Vibeke Brinck, Joanne Brooker, Camilla Brorsson, Andras Buki, Monika Bullinger, Manuel Cabeleira, Alessio Caccioppola, Emiliana Calappi, Maria Rosa Calvi, Peter Cameron, Guillermo Carbayo Lozano, Marco Carbonara, Simona Cavallo, Giorgio Chevallard, Arturo Chieregato, Giuseppe Citerio, Iris Ceyisakar, Hans Clusmann, Mark Coburn, Jonathan Coles, Jamie D. Cooper, Marta Correia, Amra Čović, Nicola Curry, Endre Czeiter, Marek Czosnyka, Claire Dahyot-Fizelier, Paul Dark, Helen Dawes, Véronique De Keyser, Vincent Degos, Francesco Della Corte, Hugo den Boogert, Bart Depreitere, Đula Đilvesi, Abhishek Dixit, Emma Donoghue, Jens Dreier, Guy Loup Dulière, Ari Ercole, Patrick Esser, Erzsébet Ezer, Martin Fabricius, Valery L. Feigin, Kelly Foks, Shirin Frisvold, Alex Furmanov, Pablo Gagliardo, Damien Galanaud, Dashiell Gantner, Guoyi Gao, Pradeep George, Alexandre Ghuysen, Lelde Giga, Ben Glocker, Jagoš Golubovic, Pedro A. Gomez, Johannes Gratz, Benjamin Gravesteijn, Francesca Grossi, Russell L. Gruen, Deepak Gupta, Juanita A. Haagsma, Iain Haitsma, Raimund Helbok, Eirik Helseth, Lindsay Horton, Jilske Huijben, Peter J. Hutchinson, Bram Jacobs, Stefan Jankowski, Mike Jarrett, Ji yao Jiang, Faye Johnson, Kelly Jones, Mladen Karan, Angelos G. Kolias, Erwin Kompanje, Daniel Kondziella, Evgenios Koraropoulos, Lars Owe Koskinen, Noémi Kovács, Ana Kowark, Alfonso Lagares, Linda Lanyon, Steven Laureys, Didier Ledoux, Rolf Lefering, Valerie Legrand, Aurelie Lejeune, Leon Levi, Roger Lightfoot, Andrew I.R. Maas, Ana M. Castaño-León, Marc Maegele, Marek Majdan, Alex Manara, Geoffrey Manley, Costanza Martino, Hugues Maréchal, Julia Mattern, Catherine McMahon, Béla Melegh, Tomas Menovsky, Ana Mikolic, Benoit Misset, Visakh Muraleedharan, Lynnette Murray, Ancuta Negru, David Nelson, Virginia Newcombe, József Nyirádi, Otesile Olubukola, Matej Oresic, Fabrizio Ortolano, Aarno Palotie, Paul M. Parizel, Jean François Payen, Natascha Perera, Vincent Perlbarg, Paolo Persona, Wilco Peul, Anna Piippo-Karjalainen, Matti Pirinen, Horia Ples, Suzanne Polinder, Inigo Pomposo, Jussi P. Posti, Louis Puybasset, Andreea Radoi, Arminas Ragauskas, Rahul Raj, Malinka Rambadagalla, Jonathan Rhodes, Sylvia Richardson, Sophie Richter, Samuli Ripatti, Saulius Rocka, Cecilie Roe, Olav Roise, Jonathan Rosand, Jeffrey V. Rosenfeld, Christina Rosenlund, Guy Rosenthal, Rolf Rossaint, Sandra Rossi, Daniel Rueckert, Martin Rusnák, Juan Sahuquillo, Oliver Sakowitz, Renan Sanchez-Porras, Janos Sandor, Nadine Schäfer, Silke Schmidt, Herbert Schoechl, Guus Schoonman, Rico Frederik Schou, Elisabeth Schwendenwein, Charlie Sewalt, Toril Skandsen, Peter Smielewski, Abayomi Sorinola, Emmanuel Stamatakis, Simon Stanworth, Robert Stevens, William Stewart, Ewout W. Steyerberg, Nino Stocchetti, Nina Sundström, Anneliese Synnot, Riikka Takala, Viktória Tamás, Tomas Tamosuitis, Mark Steven Taylor, Braden Te Ao, Olli Tenovuo, Alice Theadom, Matt Thomas, Dick Tibboel, Marjolein Timmers, Christos Tolias, Tony Trapani, Cristina Maria Tudora, Peter Vajkoczy, Shirley Vallance, Egils Valeinis, Zoltán Vámos, Mathieu van der Jagt, Gregory Van der Steen, Joukje van der Naalt, Jeroen T.J.M. van Dijck, Thomas A. van Essen, Wim Van Hecke, Caroline van Heugten, Dominique Van Praag, Thijs Vande Vyvere, Roel P.J. van Wijk, Alessia Vargiolu, Emmanuel Vega, Kimberley Velt, Jan Verheyden, Paul M. Vespa, Anne Vik, Rimantas Vilcinis, Victor Volovici, Nicole von Steinbüchel, Daphne Voormolen, Petar Vulekovic, Kevin K.W. Wang, Eveline Wiegers, Guy Williams, Lindsay Wilson, Stefan Winzeck, Stefan Wolf, Zhihui Yang, Peter Ylén, Alexander Younsi, Frederick A. Zeiler, Veronika Zelinkova, Agate Ziverte, Tommaso Zoerle

Research output: Contribution to journal › Article › peer-review

24 Scopus citations

Abstract

Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221.

Original language	English
Pages (from-to)	505-517
Number of pages	13
Journal	British Journal of Anaesthesia
Volume	125
Issue number	4
DOIs	https://doi.org/10.1016/j.bja.2020.05.067
State	Published - Oct 2020
Externally published	Yes

Keywords

Europe
effectiveness
neurological outcome
prehospital
tracheal intubation
traumatic brain injury

Access to Document

10.1016/j.bja.2020.05.067

Cite this

Gravesteijn, B. Y., Sewalt, C. A., Nieboer, D., Menon, D. K., Maas, A., Lecky, F., Klimek, M., Lingsma, H. F., Åkerlund, C., Amrein, K., Andelic, N., Andreassen, L., Anke, A., Antoni, A., Audibert, G., Azouvi, P., Azzolini, M. L., Bartels, R., Barzó, P., ... Zoerle, T. (2020). Tracheal intubation in traumatic brain injury: a multicentre prospective observational study. British Journal of Anaesthesia, 125(4), 505-517. https://doi.org/10.1016/j.bja.2020.05.067

@article{6d3f85df1a2c4890951ee4c27b48e7fb,

title = "Tracheal intubation in traumatic brain injury: a multicentre prospective observational study",

abstract = "Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221.",

keywords = "Europe, effectiveness, neurological outcome, prehospital, tracheal intubation, traumatic brain injury",

author = "Gravesteijn, {Benjamin Yael} and Sewalt, {Charlie Aletta} and Daan Nieboer and Menon, {David Krishna} and Andrew Maas and Fiona Lecky and Markus Klimek and Lingsma, {Hester Floor} and Cecilia {\AA}kerlund and Krisztina Amrein and Nada Andelic and Lasse Andreassen and Audny Anke and Anna Antoni and G{\'e}rard Audibert and Philippe Azouvi and Azzolini, {Maria Luisa} and Ronald Bartels and P{\'a}l Barz{\'o} and Romuald Beauvais and Ronny Beer and Bellander, {Bo Michael} and Antonio Belli and Habib Benali and Maurizio Berardino and Luigi Beretta and Morten Blaabjerg and Peter Bragge and Alexandra Brazinova and Vibeke Brinck and Joanne Brooker and Camilla Brorsson and Andras Buki and Monika Bullinger and Manuel Cabeleira and Alessio Caccioppola and Emiliana Calappi and Calvi, {Maria Rosa} and Peter Cameron and Lozano, {Guillermo Carbayo} and Marco Carbonara and Simona Cavallo and Giorgio Chevallard and Arturo Chieregato and Giuseppe Citerio and Iris Ceyisakar and Hans Clusmann and Mark Coburn and Jonathan Coles and Cooper, {Jamie D.} and Marta Correia and Amra {\v C}ovi{\'c} and Nicola Curry and Endre Czeiter and Marek Czosnyka and Claire Dahyot-Fizelier and Paul Dark and Helen Dawes and {De Keyser}, V{\'e}ronique and Vincent Degos and {Della Corte}, Francesco and Boogert, {Hugo den} and Bart Depreitere and {\D}ula {\D}ilvesi and Abhishek Dixit and Emma Donoghue and Jens Dreier and Duli{\`e}re, {Guy Loup} and Ari Ercole and Patrick Esser and Erzs{\'e}bet Ezer and Martin Fabricius and Feigin, {Valery L.} and Kelly Foks and Shirin Frisvold and Alex Furmanov and Pablo Gagliardo and Damien Galanaud and Dashiell Gantner and Guoyi Gao and Pradeep George and Alexandre Ghuysen and Lelde Giga and Ben Glocker and Jago{\v s} Golubovic and Gomez, {Pedro A.} and Johannes Gratz and Benjamin Gravesteijn and Francesca Grossi and Gruen, {Russell L.} and Deepak Gupta and Haagsma, {Juanita A.} and Iain Haitsma and Raimund Helbok and Eirik Helseth and Lindsay Horton and Jilske Huijben and Hutchinson, {Peter J.} and Bram Jacobs and Stefan Jankowski and Mike Jarrett and Jiang, {Ji yao} and Faye Johnson and Kelly Jones and Mladen Karan and Kolias, {Angelos G.} and Erwin Kompanje and Daniel Kondziella and Evgenios Koraropoulos and Koskinen, {Lars Owe} and No{\'e}mi Kov{\'a}cs and Ana Kowark and Alfonso Lagares and Linda Lanyon and Steven Laureys and Didier Ledoux and Rolf Lefering and Valerie Legrand and Aurelie Lejeune and Leon Levi and Roger Lightfoot and Maas, {Andrew I.R.} and Casta{\~n}o-Le{\'o}n, {Ana M.} and Marc Maegele and Marek Majdan and Alex Manara and Geoffrey Manley and Costanza Martino and Hugues Mar{\'e}chal and Julia Mattern and Catherine McMahon and B{\'e}la Melegh and Tomas Menovsky and Ana Mikolic and Benoit Misset and Visakh Muraleedharan and Lynnette Murray and Ancuta Negru and David Nelson and Virginia Newcombe and J{\'o}zsef Nyir{\'a}di and Otesile Olubukola and Matej Oresic and Fabrizio Ortolano and Aarno Palotie and Parizel, {Paul M.} and Payen, {Jean Fran{\c c}ois} and Natascha Perera and Vincent Perlbarg and Paolo Persona and Wilco Peul and Anna Piippo-Karjalainen and Matti Pirinen and Horia Ples and Suzanne Polinder and Inigo Pomposo and Posti, {Jussi P.} and Louis Puybasset and Andreea Radoi and Arminas Ragauskas and Rahul Raj and Malinka Rambadagalla and Jonathan Rhodes and Sylvia Richardson and Sophie Richter and Samuli Ripatti and Saulius Rocka and Cecilie Roe and Olav Roise and Jonathan Rosand and Rosenfeld, {Jeffrey V.} and Christina Rosenlund and Guy Rosenthal and Rolf Rossaint and Sandra Rossi and Daniel Rueckert and Martin Rusn{\'a}k and Juan Sahuquillo and Oliver Sakowitz and Renan Sanchez-Porras and Janos Sandor and Nadine Sch{\"a}fer and Silke Schmidt and Herbert Schoechl and Guus Schoonman and Schou, {Rico Frederik} and Elisabeth Schwendenwein and Charlie Sewalt and Toril Skandsen and Peter Smielewski and Abayomi Sorinola and Emmanuel Stamatakis and Simon Stanworth and Robert Stevens and William Stewart and Steyerberg, {Ewout W.} and Nino Stocchetti and Nina Sundstr{\"o}m and Anneliese Synnot and Riikka Takala and Vikt{\'o}ria Tam{\'a}s and Tomas Tamosuitis and Taylor, {Mark Steven} and Ao, {Braden Te} and Olli Tenovuo and Alice Theadom and Matt Thomas and Dick Tibboel and Marjolein Timmers and Christos Tolias and Tony Trapani and Tudora, {Cristina Maria} and Peter Vajkoczy and Shirley Vallance and Egils Valeinis and Zolt{\'a}n V{\'a}mos and {van der Jagt}, Mathieu and {Van der Steen}, Gregory and {van der Naalt}, Joukje and {van Dijck}, {Jeroen T.J.M.} and {van Essen}, {Thomas A.} and {Van Hecke}, Wim and {van Heugten}, Caroline and {Van Praag}, Dominique and Vyvere, {Thijs Vande} and {van Wijk}, {Roel P.J.} and Alessia Vargiolu and Emmanuel Vega and Kimberley Velt and Jan Verheyden and Vespa, {Paul M.} and Anne Vik and Rimantas Vilcinis and Victor Volovici and {von Steinb{\"u}chel}, Nicole and Daphne Voormolen and Petar Vulekovic and Wang, {Kevin K.W.} and Eveline Wiegers and Guy Williams and Lindsay Wilson and Stefan Winzeck and Stefan Wolf and Zhihui Yang and Peter Yl{\'e}n and Alexander Younsi and Zeiler, {Frederick A.} and Veronika Zelinkova and Agate Ziverte and Tommaso Zoerle",

note = "Publisher Copyright: {\textcopyright} 2020 The Author(s)",

year = "2020",

month = oct,

doi = "10.1016/j.bja.2020.05.067",

language = "English",

volume = "125",

pages = "505--517",

journal = "British Journal of Anaesthesia",

issn = "0007-0912",

publisher = "Elsevier Ltd.",

number = "4",

}

Gravesteijn, BY, Sewalt, CA, Nieboer, D, Menon, DK, Maas, A, Lecky, F, Klimek, M, Lingsma, HF, Åkerlund, C, Amrein, K, Andelic, N, Andreassen, L, Anke, A, Antoni, A, Audibert, G, Azouvi, P, Azzolini, ML, Bartels, R, Barzó, P, Beauvais, R, Beer, R, Bellander, BM, Belli, A, Benali, H, Berardino, M, Beretta, L, Blaabjerg, M, Bragge, P, Brazinova, A, Brinck, V, Brooker, J, Brorsson, C, Buki, A, Bullinger, M, Cabeleira, M, Caccioppola, A, Calappi, E, Calvi, MR, Cameron, P, Lozano, GC, Carbonara, M, Cavallo, S, Chevallard, G, Chieregato, A, Citerio, G, Ceyisakar, I, Clusmann, H, Coburn, M, Coles, J, Cooper, JD, Correia, M, Čović, A, Curry, N, Czeiter, E, Czosnyka, M, Dahyot-Fizelier, C, Dark, P, Dawes, H, De Keyser, V, Degos, V, Della Corte, F, Boogert, HD, Depreitere, B, Đilvesi, Đ, Dixit, A, Donoghue, E, Dreier, J, Dulière, GL, Ercole, A, Esser, P, Ezer, E, Fabricius, M, Feigin, VL, Foks, K, Frisvold, S, Furmanov, A, Gagliardo, P, Galanaud, D, Gantner, D, Gao, G, George, P, Ghuysen, A, Giga, L, Glocker, B, Golubovic, J, Gomez, PA, Gratz, J, Gravesteijn, B, Grossi, F, Gruen, RL, Gupta, D, Haagsma, JA, Haitsma, I, Helbok, R, Helseth, E, Horton, L, Huijben, J, Hutchinson, PJ, Jacobs, B, Jankowski, S, Jarrett, M, Jiang, JY, Johnson, F, Jones, K, Karan, M, Kolias, AG, Kompanje, E, Kondziella, D, Koraropoulos, E, Koskinen, LO, Kovács, N, Kowark, A, Lagares, A, Lanyon, L, Laureys, S, Ledoux, D, Lefering, R, Legrand, V, Lejeune, A, Levi, L, Lightfoot, R, Maas, AIR, Castaño-León, AM, Maegele, M, Majdan, M, Manara, A, Manley, G, Martino, C, Maréchal, H, Mattern, J, McMahon, C, Melegh, B, Menovsky, T, Mikolic, A, Misset, B, Muraleedharan, V, Murray, L, Negru, A, Nelson, D, Newcombe, V, Nyirádi, J, Olubukola, O, Oresic, M, Ortolano, F, Palotie, A, Parizel, PM, Payen, JF, Perera, N, Perlbarg, V, Persona, P, Peul, W, Piippo-Karjalainen, A, Pirinen, M, Ples, H, Polinder, S, Pomposo, I, Posti, JP, Puybasset, L, Radoi, A, Ragauskas, A, Raj, R, Rambadagalla, M, Rhodes, J, Richardson, S, Richter, S, Ripatti, S, Rocka, S, Roe, C, Roise, O, Rosand, J, Rosenfeld, JV, Rosenlund, C, Rosenthal, G, Rossaint, R, Rossi, S, Rueckert, D, Rusnák, M, Sahuquillo, J, Sakowitz, O, Sanchez-Porras, R, Sandor, J, Schäfer, N, Schmidt, S, Schoechl, H, Schoonman, G, Schou, RF, Schwendenwein, E, Sewalt, C, Skandsen, T, Smielewski, P, Sorinola, A, Stamatakis, E, Stanworth, S, Stevens, R, Stewart, W, Steyerberg, EW, Stocchetti, N, Sundström, N, Synnot, A, Takala, R, Tamás, V, Tamosuitis, T, Taylor, MS, Ao, BT, Tenovuo, O, Theadom, A, Thomas, M, Tibboel, D, Timmers, M, Tolias, C, Trapani, T, Tudora, CM, Vajkoczy, P, Vallance, S, Valeinis, E, Vámos, Z, van der Jagt, M, Van der Steen, G, van der Naalt, J, van Dijck, JTJM, van Essen, TA, Van Hecke, W, van Heugten, C, Van Praag, D, Vyvere, TV, van Wijk, RPJ, Vargiolu, A, Vega, E, Velt, K, Verheyden, J, Vespa, PM, Vik, A, Vilcinis, R, Volovici, V, von Steinbüchel, N, Voormolen, D, Vulekovic, P, Wang, KKW, Wiegers, E, Williams, G, Wilson, L, Winzeck, S, Wolf, S, Yang, Z, Ylén, P, Younsi, A, Zeiler, FA, Zelinkova, V, Ziverte, A & Zoerle, T 2020, 'Tracheal intubation in traumatic brain injury: a multicentre prospective observational study', British Journal of Anaesthesia, vol. 125, no. 4, pp. 505-517. https://doi.org/10.1016/j.bja.2020.05.067

TY - JOUR

T1 - Tracheal intubation in traumatic brain injury

T2 - a multicentre prospective observational study

AU - Gravesteijn, Benjamin Yael

AU - Sewalt, Charlie Aletta

AU - Nieboer, Daan

AU - Menon, David Krishna

AU - Maas, Andrew

AU - Lecky, Fiona

AU - Klimek, Markus

AU - Lingsma, Hester Floor

AU - Åkerlund, Cecilia

AU - Amrein, Krisztina

AU - Andelic, Nada

AU - Andreassen, Lasse

AU - Anke, Audny

AU - Antoni, Anna

AU - Audibert, Gérard

AU - Azouvi, Philippe

AU - Azzolini, Maria Luisa

AU - Bartels, Ronald

AU - Barzó, Pál

AU - Beauvais, Romuald

AU - Beer, Ronny

AU - Bellander, Bo Michael

AU - Belli, Antonio

AU - Benali, Habib

AU - Berardino, Maurizio

AU - Beretta, Luigi

AU - Blaabjerg, Morten

AU - Bragge, Peter

AU - Brazinova, Alexandra

AU - Brinck, Vibeke

AU - Brooker, Joanne

AU - Brorsson, Camilla

AU - Buki, Andras

AU - Bullinger, Monika

AU - Cabeleira, Manuel

AU - Caccioppola, Alessio

AU - Calappi, Emiliana

AU - Calvi, Maria Rosa

AU - Cameron, Peter

AU - Lozano, Guillermo Carbayo

AU - Carbonara, Marco

AU - Cavallo, Simona

AU - Chevallard, Giorgio

AU - Chieregato, Arturo

AU - Citerio, Giuseppe

AU - Ceyisakar, Iris

AU - Clusmann, Hans

AU - Coburn, Mark

AU - Coles, Jonathan

AU - Cooper, Jamie D.

AU - Correia, Marta

AU - Čović, Amra

AU - Curry, Nicola

AU - Czeiter, Endre

AU - Czosnyka, Marek

AU - Dahyot-Fizelier, Claire

AU - Dark, Paul

AU - Dawes, Helen

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AU - Degos, Vincent

AU - Della Corte, Francesco

AU - Boogert, Hugo den

AU - Depreitere, Bart

AU - Đilvesi, Đula

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AU - Foks, Kelly

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AU - Gantner, Dashiell

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AU - George, Pradeep

AU - Ghuysen, Alexandre

AU - Giga, Lelde

AU - Glocker, Ben

AU - Golubovic, Jagoš

AU - Gomez, Pedro A.

AU - Gratz, Johannes

AU - Gravesteijn, Benjamin

AU - Grossi, Francesca

AU - Gruen, Russell L.

AU - Gupta, Deepak

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AU - Helbok, Raimund

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AU - Koskinen, Lars Owe

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AU - Ortolano, Fabrizio

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AU - Tamosuitis, Tomas

AU - Taylor, Mark Steven

AU - Ao, Braden Te

AU - Tenovuo, Olli

AU - Theadom, Alice

AU - Thomas, Matt

AU - Tibboel, Dick

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AU - Tolias, Christos

AU - Trapani, Tony

AU - Tudora, Cristina Maria

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AU - Vallance, Shirley

AU - Valeinis, Egils

AU - Vámos, Zoltán

AU - van der Jagt, Mathieu

AU - Van der Steen, Gregory

AU - van der Naalt, Joukje

AU - van Dijck, Jeroen T.J.M.

AU - van Essen, Thomas A.

AU - Van Hecke, Wim

AU - van Heugten, Caroline

AU - Van Praag, Dominique

AU - Vyvere, Thijs Vande

AU - van Wijk, Roel P.J.

AU - Vargiolu, Alessia

AU - Vega, Emmanuel

AU - Velt, Kimberley

AU - Verheyden, Jan

AU - Vespa, Paul M.

AU - Vik, Anne

AU - Vilcinis, Rimantas

AU - Volovici, Victor

AU - von Steinbüchel, Nicole

AU - Voormolen, Daphne

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AU - Wang, Kevin K.W.

AU - Wiegers, Eveline

AU - Williams, Guy

AU - Wilson, Lindsay

AU - Winzeck, Stefan

AU - Wolf, Stefan

AU - Yang, Zhihui

AU - Ylén, Peter

AU - Younsi, Alexander

AU - Zeiler, Frederick A.

AU - Zelinkova, Veronika

AU - Ziverte, Agate

AU - Zoerle, Tommaso

PY - 2020/10

Y1 - 2020/10

N2 - Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221.

AB - Background: We aimed to study the associations between pre- and in-hospital tracheal intubation and outcomes in traumatic brain injury (TBI), and whether the association varied according to injury severity. Methods: Data from the international prospective pan-European cohort study, Collaborative European NeuroTrauma Effectiveness Research for TBI (CENTER-TBI), were used (n=4509). For prehospital intubation, we excluded self-presenters. For in-hospital intubation, patients whose tracheas were intubated on-scene were excluded. The association between intubation and outcome was analysed with ordinal regression with adjustment for the International Mission for Prognosis and Analysis of Clinical Trials in TBI variables and extracranial injury. We assessed whether the effect of intubation varied by injury severity by testing the added value of an interaction term with likelihood ratio tests. Results: In the prehospital analysis, 890/3736 (24%) patients had their tracheas intubated at scene. In the in-hospital analysis, 460/2930 (16%) patients had their tracheas intubated in the emergency department. There was no adjusted overall effect on functional outcome of prehospital intubation (odds ratio=1.01; 95% confidence interval, 0.79–1.28; P=0.96), and the adjusted overall effect of in-hospital intubation was not significant (odds ratio=0.86; 95% confidence interval, 0.65–1.13; P=0.28). However, prehospital intubation was associated with better functional outcome in patients with higher thorax and abdominal Abbreviated Injury Scale scores (P=0.009 and P=0.02, respectively), whereas in-hospital intubation was associated with better outcome in patients with lower Glasgow Coma Scale scores (P=0.01): in-hospital intubation was associated with better functional outcome in patients with Glasgow Coma Scale scores of 10 or lower. Conclusion: The benefits and harms of tracheal intubation should be carefully evaluated in patients with TBI to optimise benefit. This study suggests that extracranial injury should influence the decision in the prehospital setting, and level of consciousness in the in-hospital setting. Clinical trial registration: NCT02210221.

KW - Europe

KW - effectiveness

KW - neurological outcome

KW - prehospital

KW - tracheal intubation

KW - traumatic brain injury

UR - http://www.scopus.com/inward/record.url?scp=85088991849&partnerID=8YFLogxK

U2 - 10.1016/j.bja.2020.05.067

DO - 10.1016/j.bja.2020.05.067

M3 - Article

C2 - 32747075

AN - SCOPUS:85088991849

SN - 0007-0912

VL - 125

SP - 505

EP - 517

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

IS - 4

ER -

Tracheal intubation in traumatic brain injury: a multicentre prospective observational study

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