Prehospital Airway Procedures Performed in Trauma Patients by Ground Forces in Afghanistan

AbstractBackgroundAirway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4-7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield.MethodsThis study is a retrospective review of casualties that required a prehospital life-saving airway intervention during combat operations in Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR) that was linked to the Department of Defense Trauma Registry (DoDTR) for outcome data for the time period between January 2013 and September 2014.Results705 total trauma patients were included, 16.9% required a prehospital airway management procedure. There were 132 total airway procedures performed, including 83 (63.4%) endotracheal intubations and 26 (19.8%) nasopharyngeal airway placements. Combat medics were involved in 48 (36.4%) of airway cases and medical officers in 73 (55.3%). Most (94.2%) patients underwent airway procedures due to battle injuries caused by explosion or gunshot wounds. Casualties requiring airway management were more severely injured and less likely to survive as indicated by injury severity score, responsiveness level, Glascow coma score, and outcome.ConclusionsPercentages of airway interventions more than tripled from previous reports from the wars in Afghanistan and Iraq. These changes are significant and further study is needed to determine the causes. Casualties requiring airway interventions sustained more severe injuries and experienced lower survival than patients who did not undergo an airway procedure, findings suggested in previous reports.Level of EvidenceLevel III, prognostic and epidemiological. Background Airway management is of critical importance in combat trauma patients. Airway compromise is the second leading cause of potentially survivable death on the battlefield and accounts for approximately 1 in 10 preventable deaths. Reports from the Iraq and Afghanistan wars indicate 4-7% incidence of airway interventions on casualties transported to combat hospitals. The goal of this study was to describe airway management in the prehospital combat setting and document airway devices used on the battlefield. Methods This study is a retrospective review of casualties that required a prehospital life-saving airway intervention during combat operations in Afghanistan. We obtained data from the Prehospital Trauma Registry (PHTR) that was linked to the Department of Defense Trauma Registry (DoDTR) for outcome data for the time period between January 2013 and September 2014. Results 705 total trauma patients were included, 16.9% required a prehospital airway management procedure. There were 132 total airway procedures performed, including 83 (63.4%) endotracheal intubations and 26 (19.8%) nasopharyngeal airway placements. Combat medics were involved in 48 (36.4%) of airway cases and medical officers in 73 (55.3%). Most (94.2%) patients underwent airway procedures due to battle injuries caused by explosion or gunshot wounds. Casualties requiring airway management were more severely injured and less likely to survive as indicated by injury severity score, responsiveness level, Glascow coma score, and outcome. Conclusions Percentages of airway interventions more than tripled from previous reports from the wars in Afghanistan and Iraq. These changes are significant and further study is needed to determine the causes. Casualties requiring airway interventions sustained more severe injuries and experienced lower survival than patients who did not undergo an airway procedure, findings suggested in previous reports. Level of Evidence Level III, prognostic and epidemiological. Corresponding Author: Megan Blackburn, 3698 Chambers Pass, BHT-1, JBSA Fort Sam Houston, TX 78234, 210-539-1854. megan.b.blackburn2.civ@mail.mil Conflict of Interest: The authors have no conflicts of interest to disclose. Prior presentations: Presented as a poster at the Annual Meeting of Military Health System Research Symposium, August 27-30, 2017 in Kissimmee, FL. Funding: This study was supported by the U.S. Army Medical Research and Materiel Command Tactical Combat Casualty Care Research Program. © 2018 Lippincott Williams & Wilkins, Inc.

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