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Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 1/2018

Open Access 01-12-2018 | Original research

Prehospital treatment of patients with acute intracranial pathology: adherence to guidelines and blood pressure recommendations by the Danish Air Ambulance

Authors: Joachim Juelsgaard, Leif Rognås, Lars Knudsen, Troels Martin Hansen, Mads Rasmussen

Published in: Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine | Issue 1/2018

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Abstract

Background

Hypoxia and hypotension may be associated with secondary brain injury and negative outcomes in patients with traumatic and non-traumatic intracranial pathology. Guidelines exist only for the prehospital management of patients with severe traumatic brain injury (TBI). In patients with non-traumatic intracranial pathology, TBI guideline recommendations may be applied to assess whether hypoxia and hypotension should be avoided during prehospital treatment. The main study objective was to assess the extent to which Danish Helicopter Emergency Medical Service (HEMS) critical care teams adhere to the prehospital TBI guideline recommendations for the management of patients with a clinical diagnosis of non-traumatic intracranial pathology or isolated TBI. Furthermore, in the same two groups of patients, we evaluated the adherence of the Danish HEMS critical care teams to recommendations aiming to maintain systolic blood pressure (SBP) > 110 mmHg and > 120 mmHg.

Methods

In total, 211 prehospital patient records were studied. All patients were treated for non-traumatic intracranial pathology or isolated TBI by the Danish HEMS critical care teams from October 1, 2014, to January 1, 2017. Adherence to the prehospital TBI guideline recommendations and the SBP recommendations above was assessed in non-TBI and TBI populations.

Results

The adherence rates to TBI guideline recommendations among Danish HEMS critical care teams were 69% (n = 106 [95% CI: 61–77%]) in the non-TBI population and 74% (n = 43 [95% CI: 61–85%]) in the TBI population. SBP > 110 mmHg was observed in 74% (n = 113 [95% CI: 66–81%]) and 69% (n = 40 [95% CI: 56–81%]) of cases in the non-TBI and TBI population, respectively. SBP > 120 mmHg was observed in 55% (n = 84, [95% CI: 47–63%]) of patients in the non-TBI population and 55% (n = 32 [95% CI: 42–68%]) of the patients in the TBI population.

Conclusions

Due to a lack of comparative data, it is difficult to determine the performance quality of the Danish HEMS critical care teams. Our findings may suggest that adherence to TBI guidelines and SBP recommendations needs to be a continuous focal point for the Danish HEMS to avoid secondary brain damage.
Literature
1.
2.
Paolucci S, Antonucci G, Grasso MG, Bragoni M, Coiro P, De Angelis D, et al. Functional outcome of ischemic and hemorrhagic stroke patients after inpatient rehabilitation: a matched comparison. Stroke. 2003;34(12):2861–5.CrossRefPubMed
3.
Brenner M, Stein DM, Hu PF, Aarabi B, Sheth K, Scalea TM. Traditional systolic blood pressure targets underestimate hypotension-induced secondary brain injury. J Trauma Acute Care Surg. 2012;72(5):1135–9.CrossRefPubMed
4.
Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136:1118–23.CrossRefPubMed
5.
Badjatia N, Carney N, Crocco TJ, Fallat ME, Hennes HM, Jagoda AS, et al. Guidelines for prehospital management of traumatic brain injury 2nd edition. Prehosp Emerg Care. 2008;12(Suppl 1):S1–52.CrossRefPubMed
6.
Davis DP, Dunford JV, Poste JC, Ochs M, Holbrook T, Fortlage D, Size MJ, Kennedy F, Hoyt DB. The impact of hypoxia and hyperventilation on outcome after paramedic rapid sequence intubation of severely head-injured patients. J Trauma. 2004 Jul;57(1):1–8.CrossRefPubMed
7.
Franschman G, Peerdeman SM, Greuters S, Vieveen J, Brinkman AC, Christiaans HM, et al. Prehospital endotracheal intubation in patients with severe traumatic brain injury: guidelines versus reality. Resuscitation. 2009;80(10):1147–51.CrossRefPubMed
8.
Berry C, Ley EJ, Bukur M, Malinoski D, Margulies DR, Mirocha J, et al. Redefining hypotension in traumatic brain injury. Injury. 2012;43(11):1833–7.CrossRefPubMed
9.
Moppett IK. Traumatic brain injury: assessment, resuscitation and early management. Br J Anaesth. 2007;99(1):18–31.CrossRefPubMed
10.
Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study. Eur J Emerg Med. 2014;21(6):418–23.CrossRefPubMedPubMedCentral
11.
Rognås L, Hansen TM, Kirkegaard H, Tønnesen E. Pre-hospital advanced airway management by experienced anaesthesiologists: a prospective descriptive study. Scand J Trauma Resusc Emerg Med. 2013;21:58.CrossRefPubMedPubMedCentral
12.
Andersen MS, Johnsen SP, Sørensen JN, Jepsen SB, Hansen JB, Christensen EF. Implementing a nationwide criteria-based emergency medical dispatch system: a register-based follow-up study. Scand J Trauma Resusc Emerg Med. 2013;21(1):53.CrossRefPubMedPubMedCentral
13.
Stocchetti N, Furlan A, Volta F. Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma. 1996;40(5):764–7.CrossRefPubMed
14.
Pakkanen T, Kämäräinen A, Huhtala H, Silfvast T, Nurmi J, Virkkunen I, et al. Physician-staffed helicopter emergency medical service has a beneficial impact on the incidence of prehospital hypoxia and secured airways on patients with severe traumatic brain injury. Scand J Trauma Resusc Emerg Med. 2017;25(1):94.CrossRefPubMedPubMedCentral
Metadata
Title
Prehospital treatment of patients with acute intracranial pathology: adherence to guidelines and blood pressure recommendations by the Danish Air Ambulance
Authors
Joachim Juelsgaard
Leif Rognås
Lars Knudsen
Troels Martin Hansen
Mads Rasmussen
Publication date
01-12-2018
Publisher
BioMed Central
DOI
https://doi.org/10.1186/s13049-018-0534-x

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