BACKGROUND Prehospital tracheal intubation intends to provide respiratory support and protect the airway from possible pulmonary aspiration. Trauma guidelines recommend tracheal intubation in patients with a Glasgow Coma Scale (GCS) score of <9. OBJECTIVE(S) We hypothesised that in clinical practice, GCS scores before prehospital tracheal intubation are lower in trauma and medical patients. DESIGN Retrospective observational cohort study SETTING Swiss anaesthetist-staffed helicopter emergency medical system between 07 September 2020 and 11 December 2023. PATIENTS Intubated trauma and nontrauma patients ≥18 years and nonintubated patients with GCS <9 admitted to three tertiary referral Swiss hospitals. INTERVENTIONS Prehospital tracheal intubation MAIN OUTCOME MEASURES GCS score before prehospital tracheal intubation. Association of GCS score before prehospital tracheal intubation with length of ventilator days, intensive care unit stay, hospitalisation, and 28-day survival. RESULTS We screened 35 021 missions, of which 401 (335 intubated vs. 66 nonintubated) met inclusion criteria. The median GCS before prehospital tracheal intubation was 4 [IQR 3 to 6] for nontrauma and 6 [3 to 8] for trauma patients. Trauma patients with burns had a GCS score of 14 [13 to 15] before prehospital tracheal intubation. In the trauma cohort, women had a median GCS score of 5 [3 to 7] compared to men with 6 [3 to 8] (P = 0.043). The GCS before prehospital tracheal intubation was associated with length of intensive care unit stay (P = 0.042) and survival (P = 0.036) but not with length of ventilation and hospital stay. CONCLUSIONS Overall median GCS score before prehospital tracheal intubation was lower than 8. Our data suggests that the GCS score is not suitable as the sole indicator for prehospital tracheal intubation. Further randomised controlled trials should investigate more robust intubation criteria to be included in the guidelines for trauma and nontrauma patients. Finally, a patient-centred approach should be emphasised, especially in patients with burns. TRIAL REGISTRATION N/A.

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