Haemodynamic response to pre-hospital emergency anaesthesia in trauma patients within an urban helicopter emergency medical service.

Autor: Bayliss RA; London's Air Ambulance, Barts Health NHS Trust, London, UK. richard.bayliss@doctors.org.uk.; Leeds Teaching Hospitals NHS Trust, Leeds, UK. richard.bayliss@doctors.org.uk., Bird R; London's Air Ambulance, Barts Health NHS Trust, London, UK., Turner J; London's Air Ambulance, Barts Health NHS Trust, London, UK.; Nottingham University Hospitals NHS Trust, Nottingham, UK., Chatterjee D; London's Air Ambulance, Barts Health NHS Trust, London, UK.; Guys and St Thomas' NHS Foundation Trust, London, UK., Lockey DJ; London's Air Ambulance, Barts Health NHS Trust, London, UK.
Jazyk: angličtina
Zdroj: European journal of trauma and emergency surgery : official publication of the European Trauma Society [Eur J Trauma Emerg Surg] 2024 Jun; Vol. 50 (3), pp. 987-994. Date of Electronic Publication: 2024 Feb 01.
DOI: 10.1007/s00068-024-02463-5
Abstrakt: Purpose: Pre-hospital emergency anaesthesia is routinely used in the care of severely injured patients by pre-hospital critical care services. Anaesthesia, intubation, and positive pressure ventilation may lead to haemodynamic instability. The aim of this study was to identify the frequency of new-onset haemodynamic instability after induction in trauma patients with a standardised drug regime.
Methods: A retrospective database analysis was undertaken of all adult patients treated by a physician-led urban pre-hospital care service over a 6-year period. The primary outcome measure was the frequency of new haemodynamic instability following pre-hospital emergency anaesthesia. The association of patient characteristics and drug regimes with new haemodynamic instability was also analysed.
Results: A total of 1624 patients were included. New haemodynamic instability occurred in 231 patients (17.4%). Patients where a full-dose regime was administered were less likely to experience new haemodynamic instability than those who received a modified dose regime (9.7% vs 24.8%, p < 0.001). The use of modified drug regimes became more common over the study period (p < 0.001) but there was no change in the rates of pre-existing (p = 0.22), peri-/post-anaesthetic (p = 0.36), or new haemodynamic instability (p = 0.32).
Conclusion: New haemodynamic instability within the first 30 min following pre-hospital emergency anaesthesia in trauma patients is common despite reduction of sedative drug doses to minimise their haemodynamic impact. It is important to identify non-drug factors that may improve cardiovascular stability in this group to optimise the care received by these patients.
(© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.)
Databáze: MEDLINE
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