Abstract
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA) and intracerebral- and subarachnoid hemorrhage (ICH/SAH) are conditions associated with high mortality and morbidity. The aim of this study was to investigate the feasibility of obtaining continuous physiologic data and to identify possible harmful physiological deviations in these patients, in the early phases of emergency care. Patients with ICH/SAH, OHCA and severe TBI treated by the Physician-staffed Emergency Medical Service (P-EMS) between September and December 2016 were included. Physiological data were obtained from site of injury/illness, during transport, in the emergency department (ED) and until 3 h after admittance to the intensive care unit. Physiological deviations were based on predefined target values within each 5-min interval. 13 patients were included in the study, of which 38% survived. All patients experienced one or more episodes of hypoxia, 38% experienced episodes of hypercapnia and 46% experienced episodes of hypotension. The mean proportion of time without any monitoring in the pre-hospital phase was 29%, 47% and 56% for SpO2, end-tidal CO2 and systolic blood pressure, respectively. For the ED these proportions were 57%, 71% and 56%, respectively. Continuous physiological data was not possible to obtain in this study of critically ill and injured patients with brain injury. The patients had frequent deviations in blood pressure, SpO2 and end tidal CO2-levels, and measurements were frequently missing. There is a potential for improved monitoring as a tool for quality improvement in pre-hospital critical care.
Highlights
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA), intracerebral- and subarachnoid haemorrhage (ICH/SAH) are critical conditions associated with a high risk of poor outcome
Few studies have described the extent of physiological deviations throughout the prehospital and early in-hospital phase, which is unfortunate as these types of deviations may negatively affect patient outcomes [10]
We aimed to investigate the feasibility of obtaining continuous monitoring and identification of physiological deviations in patients with acute brain injury, in the early phases of emergency care
Summary
Severe traumatic brain injury (TBI), out-of-hospital cardiac arrest (OHCA), intracerebral- and subarachnoid haemorrhage (ICH/SAH) are critical conditions associated with a high risk of poor outcome. In the pre-hospital environment, these patients may be especially vulnerable when exposed to unfavourable physiological factors such as airway problems, hypoxia and hypotension—all factors that may negatively affect survival and cerebral outcome [7]. Physiological variables such as blood pressure, pulse oximetry (SpO2) and end tidal CO2-levels need to be well regulated to prevent hypoxia, reduced perfusion and increases in intracerebral pressure (ICP). Few studies have described the extent of physiological deviations throughout the prehospital and early in-hospital phase, which is unfortunate as these types of deviations may negatively affect patient outcomes [10]. We aimed to investigate the feasibility of obtaining continuous monitoring and identification of physiological deviations in patients with acute brain injury, in the early phases of emergency care
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