ImportanceThe Excellence in Prehospital Injury Care (EPIC) study demonstrated improved survival in patients with severe traumatic brain injury (TBI) following implementation of the prehospital treatment guidelines. The impact of implementing these guidelines in the subgroup of patients who received positive pressure ventilation (PPV) is unknown.ObjectiveTo evaluate the association of implementation of prehospital TBI evidence-based guidelines with survival among patients with prehospital PPV.Design, Setting, and ParticipantsThe EPIC study was a multisystem, intention-to-treat study using a before/after controlled design. Evidence-based guidelines were implemented by emergency medical service agencies across Arizona. This subanalysis was planned a priori and included participants who received prehospital PPV. Outcomes were compared between the preimplementation and postimplementation cohorts using logistic regression, stratified by predetermined TBI severity categories (moderate, severe, or critical). Data were collected from January 2007 to June 2017, and data were analyzed from January to February 2023.ExposureImplementation of the evidence-based guidelines for the prehospital care of patient with TBI.Main Outcomes and MeasuresThe primary outcome was survival to hospital discharge, and the secondary outcome was survival to admission.ResultsAmong the 21 852 participants in the main study, 5022 received prehospital PPV (preimplementation, 3531 participants; postimplementation, 1491 participants). Of 5022 included participants, 3720 (74.1%) were male, and the median (IQR) age was 36 (22-54) years. Across all severities combined, survival to admission improved (adjusted odds ratio [aOR], 1.59; 95% CI, 1.28-1.97), while survival to discharge did not (aOR, 0.94; 95% CI, 0.78-1.13). Within the cohort with severe TBI but not in the moderate or critical subgroups, survival to hospital admission increased (aOR, 6.44; 95% CI, 2.39-22.00), as did survival to discharge (aOR, 3.52; 95% CI, 1.96-6.34).Conclusions and RelevanceAmong patients with severe TBI who received active airway interventions in the field, guideline implementation was independently associated with improved survival to hospital admission and discharge. This was true whether they received basic airway interventions or advanced airways. These findings support the current guideline recommendations for aggressive prevention/correction of hypoxia and hyperventilation in patients with severe TBI, regardless of which airway type is used.

中文翻译：

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正压通气治疗重大脑外伤的 EMS 治疗指南

重要性院前损伤护理卓越 (EPIC) 研究表明，实施院前治疗指南后，严重创伤性脑损伤 (TBI) 患者的生存率得到改善。在接受正压通气 (PPV) 的患者亚组中实施这些指南的影响尚不清楚。目的评估院前 TBI 循证指南的实施与院前 PPV 患者生存的关系。设计、设置和参与者EPIC该研究是一项多系统、意向性治疗研究，采用前后对照设计。亚利桑那州的紧急医疗服务机构实施了循证指南。该亚分析是事先计划好的，包括接受院前 PPV 的参与者。使用逻辑回归对实施前和实施后队列之间的结果进行比较，并按预定的 TBI 严重程度类别（中度、严重或严重）进行分层。收集2007年1月至2017年6月的数据，并对2023年1月至2023年2月的数据进行分析。暴露TBI患者院前救护循证指南的实施。主要结局和措施主要结局是出院生存率，次要结局是生存至入院。结果在主要研究的 21 852 名参与者中，5022 人接受了院前 PPV（实施前，3531 名参与者；实施后，1491 名参与者）。在 5022 名参与者中，3720 名 (74.1%) 为男性，中位 (IQR) 年龄为 36 (22-54) 岁。综合所有严重程度，入院生存率有所改善（调整后比值比 [aOR]，1.59；95% CI，1.28-1.97），而出院生存率则没有改善（aOR，0.94；95% CI，0.78-1.13）。在重度 TBI 队列中，但在中度或危重亚组中，入院生存率增加（aOR，6.44；95% CI，2.39-22.00），出院生存率也增加（aOR，3.52；95% CI，1.96-22.00）。 6.34).结论和相关性在现场接受主动气道干预的严重 TBI 患者中，指南的实施与入院和出院生存率的改善独立相关。无论他们接受基本气道干预还是高级气道干预，情况都是如此。这些发现支持当前针对严重 TBI 患者积极预防/纠正缺氧和过度通气的指南建议，无论使用哪种气道类型。