Key result
In adult trauma patients undergoing prehospital emergency anaesthesia, 11.9% experienced post-induction critical hypertension, with pre-induction systolic blood pressure >140 mmHg strongly increasing the risk (OR 6.72).
Why the study?
Critical hypertension in major trauma patients is linked to increased mortality, making avoidance of extreme haemodynamic fluctuations essential during prehospital emergency anaesthesia to reduce secondary brain injury.
Observational (n=1,355)
Yes
Odds Ratio: 6.72 (95% CI 4.38–10.54)
p-value: p=<0.001
In adult trauma patients undergoing prehospital emergency anaesthesia, 11.9% experienced critical hypertension within 10 minutes, which was associated with older age, higher baseline blood pressure, and multiple intubation attempts.
May inform prehospital monitoring in trauma; leaves open whether targeting determinants improves outcomes.
BACKGROUND: Critical hypertension in major trauma patients is associated with increased mortality. Prehospital emergency anaesthesia (PHEA) is performed for 10% of the most seriously injured patients. Optimising oxygenation, ventilation, and cerebral perfusion, whilst avoiding extreme haemodynamic fluctuations are the cornerstones of reducing secondary brain injury. The aim of this study was to report the differential determinants of post-PHEA critical hypertension in a large regional dataset of trauma patients across three Helicopter Emergency Medical Service (HEMS) organisations. METHODS: A multi-centre retrospective observational study of consecutive adult trauma patients undergoing PHEA across three HEMS in the United Kingdom; 2015-2022. Critical hypertension was defined as a new systolic blood pressure (SBP) > 180mmHg within 10 min of induction of anaesthesia, or > 10% increase if the baseline SBP was > 180mmHg prior to induction. Purposeful logistical regression was used to explore variables associated with post-PHEA critical hypertension in a multivariable model. Data are reported as number (percentage), and odds ratio (OR) with 95% confidence interval (95%CI). RESULTS: 30,744 patients were attended by HEMS during the study period; 2161 received PHEA and 1355 patients were included in the final analysis. 161 (11.9%) patients had one or more new episode(s) of critical hypertension ≤ 10 min post-PHEA. Increasing age (compared with 16-34 years): 35-54 years (OR 1.76, 95%CI 1.03-3.06); 55-74 years (OR 2.00, 95%CI 1.19-3.44); ≥75 years (OR 2.38, 95%CI 1.31-4.35), pre-PHEA Glasgow Coma Scale (GCS) motor score four (OR 2.17, 95%CI 1.19-4.01) and five (OR 2.82, 95%CI 1.60-7.09), patients with a pre-PHEA SBP > 140mmHg (OR 6.72, 95%CI 4.38-10.54), and more than one intubation attempt (OR 1.75, 95%CI 1.01-2.96) were associated with post-PHEA critical hypertension. CONCLUSION: Delivery of PHEA to seriously injured trauma patients risks haemodynamic fluctuation. In adult trauma patients undergoing PHEA, 11.9% of patients experienced post-PHEA critical hypertension. Increasing age, pre-PHEA GCS motor score four and five, patients with a pre-PHEA SBP > 140mmHg, and more than intubation attempt were independently associated with post-PHEA critical hypertension.
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Sagi et al. (2023) conducted an observational in Major trauma requiring prehospital emergency anaesthesia (n=1,355). Pre-induction systolic blood pressure > 140 mmHg vs. Pre-induction systolic blood pressure 90-140 mmHg was evaluated on Post-PHEA critical hypertension (new SBP > 180mmHg ≤ 10 min of induction, or > 10% increase if baseline SBP > 180mmHg) (OR 6.72, 95% CI 4.38-10.54, p=<0.001). In adult trauma patients undergoing prehospital emergency anaesthesia, 11.9% experienced post-induction critical hypertension, with pre-induction systolic blood pressure >140 mmHg strongly increasing the risk (OR 6.72).
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