The Effects of Drug-Assisted Airway Management on Mean Arterial Pressure and Shock Index in the Presence of Trauma

Introduction—Airway management is a key component of prehospital care for seriously injured patients. Drug-assisted airway management is not a common intervention in the prehospital setting. Pharmacological and airway interventions can lead to adverse hemodynamic changes. Measuring mean arterial pressure (MAP) and shock index (SI) before and after a drug-assisted airway attempt could provide insight into the physiologic consequences of drug-assisted prehospital airway management in the trauma patient.

Objective—To measure changes in MAP or SI associated with drug-assisted advanced airway management.

Methods—A retrospective study was conducted using North Carolina Prehospital Medical Information System (PREMIS) data from July 1, 2012, to Dec. 31, 2012. Inclusion criteria consisted of prehospital trauma patients 12 years of age or more who received advanced airway management. Airway management was classified as drug-assisted if the patient received a paralytic, dissociative, benzodiazepine, or opiate medication. Generalized linear regression models were estimated. The semi-elasticity of drug-assisted airway management’s effects on MAP and SI were estimated.

Results—A total of 577 patients met inclusion criteria. Of those, 257 (44.5%) received drug-assisted airway management, with 36.9% receiving a dissociative, 40.6% a paralytic, 31.5% a benzodiazepine, and 17% an opiate drug. Analysis revealed a 72% decrease in MAP associated with attempted drug-assisted airway intervention (-0.72, p=0.002). No statistically significant difference was noted in SI with drug-assisted airway attempts (-0.15, p=0.597). A statistically significant decrease in MAP was associated with paralytics (-0.48, p=0.029), dissociatives (-0.58, p=0.007), and opiates (-0.69, p=0.004). However, benzodiazepines had no statistically significant effect on MAP (-0.38, p=0.068).

Conclusion—Mean arterial pressure decreased with the use of paralytics, dissociatives, and opiates. Administration of benzodiazepines did not significantly decrease MAP. The impact of drug-assisted airway management on shock index was not statistically significant.