Survival in Out-of-hospital Rapid Sequence Intubation of Non-Traumatic Brain Pathologies

Abstract

Non-traumatic brain pathologies are seven times more prevalent than traumatic brain injuries in patients that underwent out-of-hospital RSI in Victoria, Australia. Since the mechanisms through which RSI impacts mortality might differ between traumatic brain injuries and NTBP, and given that NTBP is very prevalent, it follows that the use of RSI in NTBP could be unsupported.

Review article: Emergency endotracheal intubation in non‐traumatic brain pathologies: A systematic review and meta‐analysis

“…). The seven studies that were not suitable for prevalence‐of‐intubation pooling had cohorts that consisted entirely of those that were intubated, making a calculation of prevalence impossible . A comprehensive listing of the 46 articles with a description of study characteristics, prevalence‐bias assessment, and intubation prevalence are shown in Table S1 …”

“…Two studies provide survival estimates for ischaemic stroke: Petchy et al showed their ED and out‐of‐hospital intubation cohort had 16% survival and Santoli et al with 28% ED‐based survival, also with no comparison groups . A further two studies report survival outcomes for a heterogeneous group of non‐traumatic brain pathologies: Fouche et al demonstrated that their out‐of‐hospital RSI cohort had a 69% survival and Pakkanen et al showed a 65% intubation survival for the non‐traumatic brain pathologies in their out‐of‐hospital study …”

“…Bernard et al conducted a randomised controlled trial for out‐of‐hospital rapid sequence intubation (RSI) in head injury and found favourable neurological outcome at 6 months for paramedic RSI . However, uncertainty exists if the Bernard et al trial can be generalised to non‐traumatic brain pathologies because of differences between traumatic brain injury and non‐traumatic injuries to the brain …”

“…Patients with some types of non‐traumatic brain pathologies such as subarachnoid haemorrhage often have decreased cardiac output, in contrast to brain trauma . It follows that mechanical ventilation after intubation could impact survival differently when traumatic brain injury is compared to some non‐traumatic brain pathologies due to this difference in cardiac output . Furthermore, those intubated for traumatic brain injury tend to be younger than those with stroke, and since age is associated with increased mortality from nosocomial infections following mechanical ventilation, and given that some non‐traumatic brain pathologies such as strokes tend to be older than traumatic brain injury patients, intubation could cause more infections in stroke compared to brain trauma.…”

“…It follows that mechanical ventilation after intubation could impact survival differently when traumatic brain injury is compared to some non‐traumatic brain pathologies due to this difference in cardiac output . Furthermore, those intubated for traumatic brain injury tend to be younger than those with stroke, and since age is associated with increased mortality from nosocomial infections following mechanical ventilation, and given that some non‐traumatic brain pathologies such as strokes tend to be older than traumatic brain injury patients, intubation could cause more infections in stroke compared to brain trauma. These differing mechanisms of intubation in non‐traumatic brain pathologies versus traumatic brain injury suggest that extrapolating the traumatic brain injury evidence to non‐traumatic brain pathologies might not be reasonable.…”