Changes in anaesthetic use for trauma patients in German HEMS - a retrospective study over a ten-year period

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Arasch WafaisadeMichael Gäßler

Abstract

Airway management and use of intravenous anaesthetics to facilitate tracheal intubation after major trauma remains controversial. Numerous agents are available and used for pre-hospital rapid-sequence induction (RSI). The aim was to investigate usage and potential changes in administration of intravenous anaesthetics for pre-hospital RSI in trauma patients over a ten-year period. Based on a large helicopter emergency medical service (HEMS) database in Germany between 2006 and 2015, a total of 9720 HEMS missions after major trauma leading to RSI on scene were analysed. Administration practice of sedatives and opioids were investigated, while neuromuscular blocking agents were not documented in the database. With respect to administration of sedatives, independent from trauma mechanism and specific injury patterns the use of Etomidate decreased dramatically (52 to 6%) in favour of a more frequent use of Propofol (3 to 32%) and Ketamine (9 to 24%; all p < 0.001) from 2006 to 2015. The use of Benzodiazepines increased slightly, while the utilization rate of Barbiturates remained constant. In patients with Shock Index > 1 at initial contact, the administration rate of Etomidate dropped significantly as well. This decline was mainly ...Continue Reading

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Citations

Jun 9, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Michael GäßlerUNKNOWN TraumaRegister DGU
May 15, 2021·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Pascale AveryDavid Lockey

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