• Steven G Schauer, Jason F Naylor, Joseph K Maddry, Denise M Beaumont, Cord W Cunningham, Megan B Blackburn, and Michael D April.
• From the US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, Texas, the 59th Medical Wing, Joint Base San Antonio-Lackland Air Force Base, Texas, the San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas, the Madigan Army Medical Center, Joint Base Lewis McChord, Washington, and the Army Medical Department Center and School Health Readiness Center of Excellence, Joint Base San Antonio-Fort Sam Houston, Texas.
• South. Med. J. 2018 Dec 1; 111 (12): 707-713.

ObjectivesAirway failures are the second leading cause of potentially preventable death on the battlefield. Improvements in airway management depend on identifying current challenges. We sought to build on previously reported data on prehospital, combat airway management.MethodsWe used a series of emergency department procedure codes to identify patients within the Department of Defense Trauma Registry from January 2007 to August 2016. This is a subanalysis of those with a documented prehospital airway intervention.ResultsOf the 28,222 patients in our dataset, 1379 (4.9%) had a documented prehospital airway intervention. Airway devices consisted of 49 airway adjuncts (17 nasopharyngeal airways, 2 oropharyngeal airways, remainder listed as unspecified), 230 cricothyrotomies, 1117 endotracheal intubations, and 27 supraglottic airways. Patients undergoing airway intervention were mostly members of the US military (42.2%). Compared with those without airway intervention, they were slightly younger (median 24 vs 25 years, P < 0.001), more frequently injured by explosives (57.7% vs 55.2%, P < 0.001) and gunshot wound (28.7% vs 23.3%, P < 0.001), with higher injury severity scores (composite and by body region) except the superficial body region, and less likely to survive to discharge (73.5% vs 96.6%, P < 0.001). Vecuronium (35.4%) and midazolam (27.9%) were the most frequently used paralytic and sedative, respectively.ConclusionsPatients undergoing airway intervention were most frequently injured by explosive or gunshot wound. Intubations and cricothyrotomies were the most frequent airway interventions performed. Patients undergoing interventions were more critically injured, with higher mortality rates. Further research is needed to determine methods to reduce mortality in this critically injured population.

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