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  • Review article: Emergency endotracheal intubation in non-traumatic brain pathologies: A systematic review and meta-analysis

    Author(s)
    Fouche, Pieter F
    Stein, Christopher
    Jennings, Paul A
    Boyle, Malcolm
    Bernard, Stephen
    Smith, Karen
    Griffith University Author(s)
    Boyle, Malcolm
    Year published
    2019
    Metadata
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    Abstract
    Endotracheal intubation is an advanced airway procedure performed in the ED and the out‐of‐hospital setting for acquired brain injuries that include non‐traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to non‐traumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non‐traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of ...
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    Endotracheal intubation is an advanced airway procedure performed in the ED and the out‐of‐hospital setting for acquired brain injuries that include non‐traumatic brain pathologies such as stroke, encephalopathies, seizures and toxidromes. Controlled trial evidence supports intubation in traumatic brain injuries, but it is not clear that this evidence can be applied to non‐traumatic brain pathologies. We sought to analyse the impact of emergency intubation on survival in non‐traumatic brain pathologies and also to quantify the prevalence of intubation in these pathologies. We conducted a systematic literature search of Medline, Embase and the Cochrane Library. Eligibility, data extraction and assessment of risk of bias were assessed independently by two reviewers. A bias‐adjusted meta‐analysis using a quality‐effects model pooled prevalence of intubation in non‐traumatic brain pathologies. Forty‐six studies were included in this systematic review. No studies were suitable for meta‐analysis the primary outcome of survival. Thirty‐nine studies reported the prevalence of intubation in non‐traumatic brain pathologies and a meta‐analysis showed that emergency intubation was used in 12% (95% CI 0–33) of pathologies. Endotracheal intubation was used commonly in haemorrhagic stroke 79% (95% CI 47–100) and to a lesser extent for seizures 18% (95% CI 10–27) and toxidromes 25% (95% CI 6–48). This systematic review shows that there is no high‐quality clinical evidence to support or refute emergency intubation in non‐traumatic brain pathologies. Our analysis shows that intubation is commonly used in non‐traumatic brain pathologies, and the need for rigorous evidence is apparent.
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    Journal Title
    EMA - Emergency Medicine Australasia
    Volume
    31
    Issue
    4
    DOI
    https://doi.org/10.1111/1742-6723.13304
    Subject
    Clinical sciences
    emergency
    endotracheal intubation
    non-traumatic brain pathologies
    Publication URI
    http://hdl.handle.net/10072/386502
    Collection
    • Journal articles

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