Impact of antiemetic use on stroke cases from the Japanese Society Aeromedical Service Registration System

Objective: The majority of antiemetic administration for preventing aspiration in stroke patients is reported to occur after hospital admission. There are no reports on pre-hospital antiemetic administration or outcomes regarding stroke patients. Therefore, this retrospective study of stroke patients was conducted using data from the Japanese Society Aeromedical Services Registration System (JSAS-R). Material and Methods: Information on patients diagnosed with stroke was collected from the JSAS-R database, including age, sex, vital signs at the time of patient contact by helicopter staff at the rendezvous point, stroke type (cerebral ischemia, cerebral hemorrhage, or subarachnoid hemorrhage), medical interventions, and survival or death within one month. The exclusion criteria were cardiac arrest at emergency medical technician contact and unknown final outcome. Subjects were divided into two groups for each type of stroke, according to whether antiemetics were administered or not, and comparisons were made between the paired groups. Results: During the study period, 1,420 cerebral ischemia, 1,250 cerebral hemorrhage, and 445 subarachnoid hemorrhage cases were included. For cerebral ischemia, there was no association between antiemetic use and outcome. However, in cases of cerebral hemorrhage, the rate of tracheal intubation was lower and the survival rate higher for the antiemetic group than the non-antiemetic group. For subarachnoid hemorrhage, the antiemetic group was older, had a better level of consciousness, a lower rate of tracheal intubation, and a higher survival rate than the non-antiemetic group. Additional multivariate analysis of the subarachnoid hemorrhage group was conducted, but antiemetic treatment was not selected as an independent factor for survival. Conclusion: In the case of cerebral hemorrhage after stroke, pre-hospital antiemetic administration may contribute to an improved outcome.