NCEPOD: Trauma - Who Cares? - London Health Programmes

8Head injury managementadequate ventilation in 245/274 cases where suffi cient datawere available to make these assessments. This means thatthere were concerns with airway management in 39 (14.3%)cases and ventilatory management in 29 (10.6%) cases.Table 70. Adequate airwayNumber of patients %Yes 234 85.7No 39 14.3Subtotal 273Insuffi cient data 47Total 320Table 71. Adequate ventilationNumber of patients %Yes 245 89.4No 29 10.6Subtotal 274Insuffi cient data 46Total 320This incidence of inadequate airway management doesnot fi t with the current guidelines for the management ofsevere head injury which state that patients who havesuffered severe head injury should be intubated andreceive ventilatory support. From Figure 33, 103 patientswith GCS less than 9 were not intubated prior to arrival athospital. It may be that the advisors did not include all theunintubated patients in the inadequate airway managementgroup as they were aware of the constraints of the currentprehospital paramedic based system (with respect to abilityto anaesthetise and intubate patients).Despite the above comments on the advisors’ opinion ofthe incidence of airway problems, and the possible underreporting of this issue, Table 72 shows that the 72 hourmortality rate more than doubled for the group of patientsthat advisors judged had received inadequate airway orventilatory management prehospital.These data serve to underline the importance of adequateairway control and avoidance of hypoxia and hypercapnia.Table 72. Adequate airway/ventilation by outcome at 72 hoursAdequate airwayAdequate ventilationYes % No % Yes % No %Alive 192 82.1 23 59.0 199 81.2 16 55.2Deceased 42 17.9 16 41.0 46 18.8 13 44.8Total 234 39 245 2989