Intubating trauma patients before reaching hospital - revisited

Endotracheal intubation is widely used for airway management in a prehospit al setting, despite a lack of controlled trials demonstrating a positive ef fect on survival or neurological outcome in adult patients. The benefits, i n term of outcomes of invasive airway management before reaching hospital, remain controversial. However, inadequate airway management in this patient population is the primary cause of preventable mortality. An increase in i ntubation failures and in the rate of complications in trauma patients shou ld induce us to improve airway management skills at the scene of trauma. If the addition of emergency physicians to a prehospital setting is to have a ny influence on outcome, further studies are merited. However, it has been established that sedation with rapid sequence intubation is superior in ter ms of success, complications and rates of intubation difficulty. Orotrachea l intubation with planned neuromuscular blockade and in-line cervical align ment remains the safest and most effective method for airway control in pat ients who are severely injured.