Background: The effective treatment of airway compromise in trauma and non-trauma patients is important.\nHypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be\nimportant quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical\ntrauma and non-trauma patients remain the two major groups to which helicopter emergency medical services\n(HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma\npatients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the\nincidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation\n(TI) by physician-staffed HEMS.\nMethods: Data were collected prospectively over a 12-month period, using a uniform Utstein-style airway\ntemplate. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral\noxygen saturation and systolic blood pressure before and after definitive airway management. Data were\nanalysed using Cochranââ?¬â??Mantelââ?¬â??Haenszel methods and mixed-effects models.\nResults: Eight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI\nwere included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared\nto trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in\nboth groups were still hypoxic at admission. For hypotension, the differences between the groups were less\nprominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There\nwas no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level\nof consciousness was the most frequent indication for TI, and was associated with increased survival to hospital\n(cOR 2.8; 95% CI: 1.4ââ?¬â??5.4). Conclusions: Our results showed that non-trauma patients had a higher incidence of hypoxia before TI than\ntrauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but\none in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible\ncauses that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival\nrates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway\nmanagement in trauma and non-trauma patients.
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