Ann Surg. 2019 Mar;269(3):e29-e30

# Prehospital Ground Transport Rapid Sequence Intubation for Trauma and Traumatic Brain Injury Outcomes.

Fitzgerald M, Lloyd-Donald P, Smit V, Mathew J, Kim Y, Tee J, Dewan Y, Mitra B

QUOTE:"We suggest that headlining the only positive, yet potentially flawed, finding of 4 secondary outcomes when the primary outcome has been refuted demands further assessment of prehospital RSI. Neurotrauma represents a significant personal, societal, and economic global health burden. It is clinically important to review any intervention as we attempt to reach an international consensus on the management of those with severe brain injury.

It is possible that a subgroup of patients, such as those transported by air or those with prolonged transport times, may benefit from prehospital RSI. However, it is equally possible that patients in urban areas, those in hemorrhagic shock and/or patients with surgically treatable brain injury may be harmed. Despite the extensively cited RCT, equipoise continues to exist and pending further trials, sound clinical judgment, which includes consideration of the benefits of early access to definitive care, should be applied before routine prehospital intubation after trauma."