"A" stands for airway - Which factors guide the need for on-scene airway management in facial fracture patients?

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Puolakkainen , T , Toivari , M , Puolakka , T & Snäll , J 2022 , ' "A" stands for airway - Which factors guide the need for on-scene airway management in facial fracture patients? ' , BMC Emergency Medicine , vol. 22 , no. 1 , 110 . https://doi.org/10.1186/s12873-022-00669-7

Title: "A" stands for airway - Which factors guide the need for on-scene airway management in facial fracture patients?
Author: Puolakkainen, Tero; Toivari, Miika; Puolakka, Tuukka; Snäll, Johanna
Contributor organization: Department of Oral and Maxillofacial Diseases
University of Helsinki
HUS Head and Neck Center
HUS Emergency Medicine and Services
Department of Diagnostics and Therapeutics
Anestesiologian yksikkö
Date: 2022-06-15
Language: eng
Number of pages: 7
Belongs to series: BMC Emergency Medicine
ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-022-00669-7
URI: http://hdl.handle.net/10138/346354
Abstract: Background Numerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management. Methods This retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria. Results Of the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital. Conclusions Proper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.
Subject: Intubation
Facial Fracture
Traumatic Brain injury
3126 Surgery, anesthesiology, intensive care, radiology
313 Dentistry
Peer reviewed: Yes
Rights: cc_by
Usage restriction: openAccess
Self-archived version: publishedVersion

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