Postintubation Hemodynamic Collapse in Traumatically Injured Critical Care Transport Patients: A Retrospective Cohort Study

Abstract

Background

Endotracheal intubation of trauma patients incurs risks including post-intubation hemodynamic collapse. Trauma patients are at increased risk of secondary harm related to hypotension. The aim of this study was to describe post-intubation hemodynamic collapse in traumatically injured CCT patients and investigate associations with in-hospital outcomes.

Methods

Retrospective chart review of trauma patients ≥18 years admitted to a rural level one trauma center who were transported and intubated by the hospital-based CCT service between January 2017 and June 2024. Hemodynamic collapse was defined as cardiac arrest, systolic blood pressure (SBP) <65 mmHg at least once, SBP <90 mmHg for greater than 30 minutes, new vasopressor requirement, vasopressor dose increase, or fluid bolus of >15 mL/kg to maintain SBP. The primary outcome was the incidence of hemodynamic collapse. Secondary outcomes were identification of potentially modifiable patient risk factors and in-hospital outcomes including length of stay and mortality.

Results

One hundred forty-two trauma patients were included. Thirty-five (24.6%) patients experienced hemodynamic collapse and 2 (5.7%) had cardiac arrest. When controlled for ISS, patients with pre-intubation blood administration (OR 5.89, 95% CI 1.8-19.31), pre-intubation vasopressors (OR 11.21, CI 2.02-62.25), and first systolic blood pressure <90 mmHg (OR 7.66, CI 1.18-49.74) had higher odds of hemodynamic collapse after intubation. The median shock index and injury severity scores (ISS) were also higher: 1.07 (0.71-1.38) versus 0.68 (0.53-0.84) and 36 (14-43) versus 24 (17-34), respectively (p <0.05). When controlled for ISS there was no significant difference in hospital mortality (OR 1.78, 95% CI 0.73-4.36).

Conclusion

Post-intubation hemodynamic collapse occurred in 1 in 4 patients in this cohort of traumatically injured patients. Patients with post-intubation hemodynamic collapse were more likely to have received blood, fluids, and vasopressors and they had higher ISS and in-hospital mortality. The risks and benefits of a definitive airway for these patients must be carefully weighed.