UMEM Educational Pearls

This study looked at survival pre and post implementation of an airway guideline for prehospital traumatic brain injury (TBI) patients who received positive pressure airway interventions.  The guideline “focused on the avoidance and aggressive treatment of hypotension and 3 airway-related goals: (1) prevention or treatment of hypoxia through early, high-flow oxygen administration; (2) airway interventions to optimize oxygenation or ventilation when high-flow oxygen was insufficient; and (3) prevention of hyperventilation or hypocapnia by using ventilation adjuncts (ie, rate timers, flow-controlled ventilation bags, end-tidal carbon dioxide monitoring).”

Post implementation, survival to admission increased in all severity levels of TBI and in the most severely injured, survival to discharge improved. 

Useful for those involved in prehospital education and as a reminder for in hospital airway management  in TBI patients.


Gaither JB, Spaite DW, Bobrow BJ, et al. EMS Treatment Guidelines in Major Traumatic Brain Injury With Positive Pressure Ventilation. JAMA Surg. 2024;159(4):363–372. doi:10.1001/jamasurg.2023.7155