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Critical hypertension in trauma patients following prehospital emergency anaesthesia: a multi-centre retrospective

Liam Sagi1, James Price2,3, Kate Lachowycz2

  • 1Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, UK. Liam.sagi@eaaa.org.uk.

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
|December 21, 2023
PubMed

Insights

Prehospital emergency anaesthesia (PHEA) in trauma patients can lead to critical hypertension. Older age, lower GCS motor scores, higher pre-PHEA SBP, and multiple intubation attempts are key risk factors.

Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Anaesthesiology

Background:

  • Critical hypertension in trauma patients correlates with higher mortality.
  • Prehospital emergency anaesthesia (PHEA) is administered to 10% of severely injured patients.
  • Optimizing physiological parameters is crucial for reducing secondary brain injury.

Purpose of the Study:

  • To identify factors associated with critical hypertension following PHEA in trauma patients.
  • To analyze a large regional dataset from three Helicopter Emergency Medical Service (HEMS) organizations.

Main Methods:

  • Multi-center retrospective observational study (2015-2022).
  • Included adult trauma patients undergoing PHEA.
  • Critical hypertension defined as SBP >180mmHg or >10% increase post-PHEA.
  • Logistic regression analysis to identify determinants.

Main Results:

  • 11.9% of 1355 analyzed patients experienced post-PHEA critical hypertension.
  • Independent predictors included increasing age, lower pre-PHEA GCS motor scores (4-5), pre-PHEA SBP >140mmHg, and multiple intubation attempts.

Conclusions:

  • PHEA in trauma patients carries a risk of hemodynamic fluctuations, specifically critical hypertension.
  • Age, GCS motor score, pre-PHEA SBP, and intubation attempts are significant independent predictors of post-PHEA critical hypertension.
Abstract

Keywords:
Air ambulanceAnaesthesiaBlood pressureHelicopter emergency medical serviceHypertensionHypotensionPrehospitalPrehospital emergency careRapid sequence inductionTrauma

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