Effectiveness of Prehospital Use of Advanced Airway Management in Traumatic Brain Injury Patients: A Systematic Review

Background: Traumatic brain injury (TBI) is a leading cause of trauma-related mortality and disability, necessitating rapid and effective airway management to prevent secondary brain injury. Establishing a definitive airway before hospital admission is often performed in the prehospital setting; however, its impact on patient outcomes remains debated. Objective: This study aimed to assess the effectiveness of prehospital advanced airway management in TBI patients by comparing mortality and morbidity outcomes between prehospital and in-hospital intubation. Methods: A systematic review was conducted following PRISMA guidelines. Five electronic databases were searched, and data extraction was performed using Endnote. Inclusion criteria encompassed observational studies, cohort studies, and randomized controlled trials (RCTs) evaluating prehospital intubation. The Newcastle-Ottawa Scale (NOS) was used to assess the risk of bias, and statistical analysis was performed to evaluate mortality and morbidity trends. Results: Despite considerable heterogeneity, no statistically significant difference in mortality was observed between prehospital and in-hospital intubation (OR = 1.08, 95% CI: 0.89–1.27, p = 0.32). However, sensitivity analysis suggested a 12% reduction in morbidity with prehospital intubation (RR = 0.88, 95% CI: 0.79–0.96), particularly when performed by trained professionals following standardized protocols. Studies incorporating rapid sequence intubation (RSI) and capnography monitoring reported improved neurological outcomes, with a 15–20% increase in favorable Glasgow Outcome Scale (GOS) scores compared to non-RSI approaches. Variability in intervention techniques, prolonged on-scene times, and inconsistent ventilation management contributed to conflicting findings, underscoring the necessity of cautious interpretation due to data variability. Conclusion: While prehospital intubation remains a critical intervention in TBI management, its superiority over in-hospital intubation remains uncertain. Standardized protocols, RSI implementation, provider training, and further high-quality RCTs are essential to establish its clinical efficacy and optimize patient outcomes.