Outcomes of Prehospital versus Emergency Department Intubation in Patients Managed by Emergency Medical Services

Abstract Introduction: Prehospital endotracheal intubation (ETI) is a critical intervention in emergency care; however, its benefit compared to ETI performed in the emergency department (ED) remains uncertain. This study aims to compare survival to hospital discharge between patients who underwent ETI in the prehospital setting versus those intubated in the ED, all managed by a single emergency medical services (EMS) system. Methods: This retrospective cohort study included adult patients treated by the EMS team of Thammasat University Hospital from January 2019 to June 2021 who received ETI either at the scene or within 1 h of ED arrival. Both prehospital and ED ETIs were performed by physicians. The primary outcome was survival to hospital discharge. The secondary outcome was length of hospital stay. Multivariable and propensity score–matched analyses were performed. Results: Of 219 included patients, 106 underwent prehospital intubation, and 113 underwent ED intubation. Survival to hospital discharge was higher in the ED group than in the prehospital group (65% vs. 26%; P < 0.001). After multivariable adjustment, this difference remained significant (adjusted risk difference RD, 28.7%; 95% confidence interval CI, 11.1–46.6). However, after propensity score matching, the difference was no longer statistically significant (RD, 3.5%; 95%CI, −22.6 to 29.7; P = 0.789). Conclusion: Among EMS-managed patients requiring ETI, ED intubation was associated with higher crude and adjusted survival; however, this association did not persist after propensity score matching. These findings suggest that baseline differences may partly explain the observed effect and underscore the need for prospective studies to clarify the comparative effectiveness of prehospital airway strategies.