Abstract
Introduction
Analysis of modern military conflicts suggests that airway compromise remains the
second leading cause of preventable death of combat fatalities. This study compares
outcomes of combat casualties that received prehospital airway interventions, specifically
bag valve mask (BVM) ventilation, cricothyrotomy, and supraglottic airway (SGA) placement.
The goal is to compare the effectiveness of airway management strategies used in the
military pre-hospital setting.
Methods
This retrospective chart review of 1267 US Army medical evacuation patient care records,
compared outcomes of casualties that received prehospital advanced airway interventions.
The patients consisted of US military injured in Operation Enduring Freedom January
2011–March 2014. Compared outcomes consisted of vent-, ICU-, and hospital-free days.
Results
Those with SGA placement experienced fewer vent-free days, ICU-free days, and hospital-free
days compared to BVM and cricothyrotomy patients. The groups did not significantly
differ in rates of 30-day survival. The odds for survival were not significantly higher
for BVM versus SGA patients (OR 1.5, 95% CI 0.2–9.8), cricothyrotomy versus SGA patients
(OR 3.9, 95% CI 0.6–24.9), or cricothyrotomy versus BVM patients (OR 2.7, 95% CI 0.5–13.8)
in a logistic regression model adjusting for GCS.
Conclusion
This study supports prehospital BVM ventilation as a possible alternative to cricothyrotomy
as there was no difference in measured outcomes between the groups. It further cautions
against SGA use in the prehospital combat setting due to higher morbidity demonstrated
by fewer ventilator, hospital, and ICU free days than those receiving cricothyrotomy
or BVM ventilation. There was no difference in 30-day survival between the groups.
Keywords
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Article Info
Publication History
Published online: February 08, 2018
Accepted:
February 8,
2018
Received in revised form:
January 11,
2018
Received:
October 25,
2017
Identification
Copyright
© 2018 Published by Elsevier Inc.
