Volume 22 Supplement 1

London Trauma Conference 2013

Open Access

Pre-hospital critical care anaesthesiologists and traumatic brain injury-guideline adherence

  • Leif Rognås1, 2, 3,
  • Troels Martin Hansen2,
  • Hans Kirkegaard3 and
  • Else Tønnesen4
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201422(Suppl 1):P7

https://doi.org/10.1186/1757-7241-22-S1-P7

Published: 7 July 2014

Background

Guidelines recommend that brain trauma patients with a Glasgow Coma Scale score <9 should have an airway established. Also, SpO2 >90%, systolic blood pressure >90 mmHg and end-tidal CO2 between 4.5 and 5.3 kPa is advised [1]. The objectives were to investigate guideline adherence, reasons for non-adherence and the incidences of complications related to pre-hospital advanced airway management in traumatic brain injury patients.

Materials and methods

We prospectively collected data [2] from eight anaesthesiologist-staffed pre-hospital critical care teams in the Central Denmark Region according to the Utstein-style template [3].

Results

Among 1081 consecutive pre-hospital advanced airway management patients, we identified 54 with a traumatic brain injury and an initial Glasgow Coma Scale score <9. Guideline adherence regarding airway management was 92.6%. Reasons for non-adherence were patient’s condition, anticipated difficult airway management and short distance to the emergency department. Following rapid sequence intubation, 11.4% suffered an oxygen saturation <90%, 9.1% had a first post-rapid sequence intubation systolic blood pressure <90 mmHg and 48.9% had a first post-rapid sequence intubation systolic blood pressure <120 mmHg. The incidence of hypertension following pre-hospital rapid sequence intubation was 4.5%. The incidence of post-endotracheal intubation hyperventilation was 71.1%.

Conclusion

The adherence to airway management guidelines was high. The incidences of post-rapid sequence intubation hypoxia and systolic blood pressure <90 compare to results reported from other physician-staffed pre-hospital services. The incidence of systolic blood pressure <120 as well as that of hyperventilation following pre-hospital endotracheal intubation in traumatic brain injury patients call for a change in our current practice.

Authors’ Affiliations

(1)
Department of Research and Development, Norwegian Air Ambulance Foundation
(2)
Pre-hospital Critical Care Team, Aarhus University Hospital
(3)
Centre for Emergency Medicine Research, Aarhus University Hospital
(4)
Department of Anaesthesiology, Aarhus University Hospital Aarhus

References

  1. Badjatia N, Carney N, Crocco TJ, et al: Guidelines for prehospital management of traumatic brain injury. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 2008, 12 (Suppl 1): S1-52. 2View ArticleGoogle Scholar
  2. Rognas L, Hansen TM, Kirkegaard H, et al: Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scandinavian journal of trauma, resuscitation and emergency medicine. 2013, 21 (1): 58-10.1186/1757-7241-21-58.PubMed CentralView ArticlePubMedGoogle Scholar
  3. Sollid SJ, Lockey D, Lossius HM: A consensus-based template for uniform reporting of data from pre-hospital advanced airway management. Scandinavian journal of trauma, resuscitation and emergency medicine. 2009, 17: 58-10.1186/1757-7241-17-58.PubMed CentralView ArticlePubMedGoogle Scholar

Copyright

© Rognås et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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