The utility of the brain trauma evidence to inform paramedic rapid sequence intubation in out-of-hospital stroke.
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.
['Fouche|Pieter Francsois|PF|0000-0002-7299-1363', 'Jennings|Paul Andrew|PA|', 'Boyle|Malcolm|M|', 'Bernard|Stephen|S|', 'Smith|Karen|K|']
D000328:Adult D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000070642:Brain Injuries, Traumatic D015897:Comorbidity D004634:Emergency Medical Technicians D005260:Female D015600:Glasgow Coma Scale D006801:Humans D016015:Logistic Models D008297:Male D008875:Middle Aged D010351:Patient Discharge D011674:Pulse D000079603:Rapid Sequence Induction and Intubation D012189:Retrospective Studies D020521:Stroke D013997:Time Factors D014739:Victoria
Paramedic Traumatic brain injury Stroke, rapid sequence intubation