THE SAFETY OF EMERGENCY NEUROMUSCULAR BLOCKADE AND OROTRACHEAL INTUBATION IN THE ACUTELY INJURED TRAUMA PATIENT

BACKGROUND: This study was done to determine the safety and success of orotracheal intubation with planned neuromuscular blockade in patient s who are severely injured. The study was performed at Carle Foundatio n Hospital, designated Level I trauma center located in east central I llinois. STUDY DESIGN: A retrospective review of the trauma registry a nd medical records of all patients requiring emergency airway control from September 1, 1987 to September 30, 1991 was performed. Two hundre d twenty-nine patients who were critically injured were reviewed, the mean injury severity score was 29 (range of 3 to 75), the mean revised trauma score was 9 (range of 3 to 12), the mean Glasgow Coma Scale wa s 9 (range of 3 to 15), and the mean age was 31 years (range of one to 94 years). RESULTS: Indications for intubation included hemodynamic i nstability or altered level of consciousness (66.4 percent), or both, combative or uncooperative behavior (33.2 percent), and need to secure airway for transport (0.4 percent). Two hundred twenty-three (97.4 pe rcent) patients were successfully intubated. Six (2.6 percent) patient s required cricothyroidotomy and one (0.4 percent) patient was aspirat ed during intubation. Eight (3.5 percent) patients had cervical spine injuries but had no complications from orotracheal intubation. In the combative group, 32 (42 percent) patients had significant head injurie s and 17 (22 percent) had other potentially hfe-threatening injuries. CONCLUSIONS: Orotracheal intubation with planned neuromuscular blockad e and in-line cervical traction is a safe, effective method for airway control in patients who are severely injured. This technique is also indicated to expedite therapy in combative, uncooperative patients bec ause of the high incidence of significant life-threatening injuries to the brain and other organs.