• Scand J Trauma Resus · Jun 2023

    Multicenter Study Observational Study

    Predictors of post-intubation hypotension in trauma patients following prehospital emergency anaesthesia: a multi-centre observational study.

    • James Price, Lyle Moncur, Kate Lachowycz, Rob Major, Liam Sagi, Sarah McLachlan, Chris Keeliher, Alistair Steel, Peter B Sherren, and BarnardEd B GEBGDepartment of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, UK.Emergency Department, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.Academic Department of Military Emergency Medicine.
    • Department of Research, Audit, Innovation, and Development, East Anglian Air Ambulance, Norwich, UK. James.price@doctors.org.uk.
    • Scand J Trauma Resus. 2023 Jun 2; 31 (1): 2626.

    BackgroundPost-intubation hypotension (PIH) after prehospital emergency anaesthesia (PHEA) is prevalent and associated with increased mortality in trauma patients. The objective of this study was to compare the differential determinants of PIH in adult trauma patients undergoing PHEA.MethodsThis multi-centre retrospective observational study was performed across three Helicopter Emergency Medical Services (HEMS) in the UK. Consecutive sampling of trauma patients who underwent PHEA using a fentanyl, ketamine, rocuronium drug regime were included, 2015-2020. Hypotension was defined as a new systolic blood pressure (SBP) < 90 mmHg within 10 min of induction, or > 10% reduction if SBP was < 90 mmHg before induction. A purposeful selection logistic regression model was used to determine pre-PHEA variables associated with PIH.ResultsDuring the study period 21,848 patients were attended, and 1,583 trauma patients underwent PHEA. The final analysis included 998 patients. 218 (21.8%) patients had one or more episode(s) of hypotension ≤ 10 min of induction. Patients > 55 years old; pre-PHEA tachycardia; multi-system injuries; and intravenous crystalloid administration before arrival of the HEMS team were the variables significantly associated with PIH. Induction drug regimes in which fentanyl was omitted (0:1:1 and 0:0:1 (rocuronium-only)) were the determinants with the largest effect sizes associated with hypotension.ConclusionThe variables significantly associated with PIH only account for a small proportion of the observed outcome. Clinician gestalt and provider intuition is likely to be the strongest predictor of PIH, suggested by the choice of a reduced dose induction and/or the omission of fentanyl during the anaesthetic for patients perceived to be at highest risk.© 2023. The Author(s).

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