The utility of the brain trauma evidence to inform paramedic rapid sequence intubation in out-of-hospital stroke
Dublin Core
Title
The utility of the brain trauma evidence to inform paramedic rapid sequence intubation in out-of-hospital stroke
Subject
Traumatic brain injury, Stroke, rapid sequence intubation, Paramedic
Description
Background
Rapid sequence intubation (RSI) is used to secure the airway of stroke patients. Randomized controlled trial
evidence exists to support the use of paramedic RSI for traumatic brain injury (TBI), but cannot necessarily be
applied to stroke RSI because of differences between the stroke and TBI patient. To understand if the TBI
evidence can be used for stroke RSI, we analysed a retrospective cohort of TBI and strokes to compare how
survival is impacted differently by RSI when comparing strokes and TBI.
Methods
This study was a retrospective analysis of 10 years of in-hospital and out-of-hospital data for all stroke and TBI
patients attended by Ambulance Victoria, Australia. Logistic regression predicted the survival for ischemic and
haemorrhagic strokes as well as TBI. The constituents of RSI, such a medications, intubation success and time
intervals were analysed against survival using interactions to asses if RSI impacts survival differently for strokes
compared to TBI.
Results
This analysis found significant interactions in the RSI-only group for age, number of intubation attempts, atropine,
fentanyl, pulse rate and perhaps scene time and time- to-RSI. Such interactions imply that RSI impact survival
differently for TBI versus strokes. Additionally, no significant difference in survival for TBI was found, with a -
0.7% lesser survival for RSI compared to no-RSI; OR 0.86 (95% CI 0.67 to 1.11; p = 0.25). Survival for
haemorrhagic stroke was - 14.1% less for RSI versus no-RSI; OR 0.44 (95% CI 0.33 to 0.58; p = 0.01) and was -
4.3%; OR 0.67 (95% CI 0.49 to 0.91; p = 0.01) lesser for ischemic strokes.
Conclusions
Rapid sequence intubation and related factors interact with stroke and TBI, which suggests that RSI effects
stroke survival in a different way from TBI. If RSI impact survival differently for strokes compared to TBI, then
perhaps the TBI evidence cannot be used for stroke RSI.
Rapid sequence intubation (RSI) is used to secure the airway of stroke patients. Randomized controlled trial
evidence exists to support the use of paramedic RSI for traumatic brain injury (TBI), but cannot necessarily be
applied to stroke RSI because of differences between the stroke and TBI patient. To understand if the TBI
evidence can be used for stroke RSI, we analysed a retrospective cohort of TBI and strokes to compare how
survival is impacted differently by RSI when comparing strokes and TBI.
Methods
This study was a retrospective analysis of 10 years of in-hospital and out-of-hospital data for all stroke and TBI
patients attended by Ambulance Victoria, Australia. Logistic regression predicted the survival for ischemic and
haemorrhagic strokes as well as TBI. The constituents of RSI, such a medications, intubation success and time
intervals were analysed against survival using interactions to asses if RSI impacts survival differently for strokes
compared to TBI.
Results
This analysis found significant interactions in the RSI-only group for age, number of intubation attempts, atropine,
fentanyl, pulse rate and perhaps scene time and time- to-RSI. Such interactions imply that RSI impact survival
differently for TBI versus strokes. Additionally, no significant difference in survival for TBI was found, with a -
0.7% lesser survival for RSI compared to no-RSI; OR 0.86 (95% CI 0.67 to 1.11; p = 0.25). Survival for
haemorrhagic stroke was - 14.1% less for RSI versus no-RSI; OR 0.44 (95% CI 0.33 to 0.58; p = 0.01) and was -
4.3%; OR 0.67 (95% CI 0.49 to 0.91; p = 0.01) lesser for ischemic strokes.
Conclusions
Rapid sequence intubation and related factors interact with stroke and TBI, which suggests that RSI effects
stroke survival in a different way from TBI. If RSI impact survival differently for strokes compared to TBI, then
perhaps the TBI evidence cannot be used for stroke RSI.
Creator
Pieter Francsois Fouche, Paul Andrew Jennings, Malcolm Boyle, Stephen Bernard and Karen Smith
Source
http://dx.doi.org/10.1186/s12873-020-0303-9
Publisher
BioMed Central Ltd
Date
Jan. 28, 2020
Contributor
Fajar bagus W
Format
PDF
Language
Indonesia
Type
Text
Files
Collection
Citation
Pieter Francsois Fouche, Paul Andrew Jennings, Malcolm Boyle, Stephen Bernard and Karen Smith, “The utility of the brain trauma evidence to inform paramedic rapid sequence intubation in out-of-hospital stroke,” Repository Horizon University Indonesia, accessed February 5, 2025, https://repository.horizon.ac.id/items/show/3535.