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

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Abstract

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.

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Data availability

Source data can be made available on request to the corresponding author.

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Acknowledgements

The authors thank Dr Mike Christian for his assistance in the development of the study, Dr Elaine Cole for her guidance with data analysis, and Christine Henry, Elizabeth Foster, Frank Chege, Dr Chloe Baker, and Dr Sophie Jefferys for their assistance with data collection.

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Authors and Affiliations

  1. London’s Air Ambulance, Barts Health NHS Trust, London, UK

    R. A. Bayliss, R. Bird, J. Turner, D. Chatterjee & D. J. Lockey

  2. Leeds Teaching Hospitals NHS Trust, Leeds, UK

    R. A. Bayliss

  3. Nottingham University Hospitals NHS Trust, Nottingham, UK

    J. Turner

  4. Guys and St Thomas’ NHS Foundation Trust, London, UK

    D. Chatterjee

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  1. R. A. Bayliss
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Contributions

Conceived and designed by JT and DC. Data collection by RB, RAB, and JT. Data reviewed and analysed by RAB, RB, and JT with further interpretation by DC and DL. Manuscript initial draft by RAB with review and further contribution by RB, JT, DC, and DL. All the authors have approved the final version of the manuscript and are accountable for all aspects of the work.

Corresponding author

Correspondence to R. A. Bayliss.

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Ethics approval

As a retrospective observational review of routinely collected data, ethical approval was not required. The study was registered with the Bart’s Health NHS Trust Clinical Effectiveness Unit (Improvement Project 11725, registered 26/11/2020). The study has been presented according to the STROBE statement principles [15].

Competing interests

The authors declare no competing interests.

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Bayliss, R.A., Bird, R., Turner, J. et al. Haemodynamic response to pre-hospital emergency anaesthesia in trauma patients within an urban helicopter emergency medical service. Eur J Trauma Emerg Surg (2024). https://doi.org/10.1007/s00068-024-02463-5

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