The Impact of Hypoxia and Hyperventilation on Outcome after Paramedic Rapid Sequence Intubation of Severely Head-Injured Patients

Abstract

Hyperventilation and severe hypoxia during paramedic RSI are associated with an increase in mortality.

Endotracheal intubation and outcome in high-risk patients with acute myocardial infarction undergoing primary angioplasty

“…found that the rate of one o more errors occurred in 444 (22.7%) patients, including tube misplacement or dislodgement in 61 (3%), multiple ETI attempts in 62 (3%) and failed ETI in 359 (15%) [24]. Furthermore, other interventions often occur concurrently with ETI like chest compressions, electrical therapy, intravenous access, or the administration of drugs and ETI may influence patient outcome by interacting with or affecting the execution of these simultaneous therapies resulting in unintended hyperventilation, which may be deleterious in certain conditions and may increase the mortality, as shown by Davis and coll [25]. These observations contradict the assumption that aggressive airway intervention is associated with improved resuscitation outcomes [26].…”

Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury

“…Positive pressure ventilation increases intrathoracic pressure, which reduces the venous return and decreases blood pressure and cardiac output. (10,22,28) Increased intrathoracic pressure can be retrogradely transmitted through the jugular venous system raising intracranial pressure as a result. (31) However, hyperventilation reduces ICP through vasoconstriction (17) and is recommended as a treatment in patients with acute brainstem herniation.…”

“…(23,24) There was no difference observed in patient outcome after pre-hospital ETI by aeromedical crew using RSI protocol compared to undergoing ETI in a trauma resuscitation suite. (25) It is reasonable to assume that the procedure (ETI) itself and possible complications (22,26,27) during ETI are connected with patient outcome. The possible detrimental impact of prehospital intubation is associated with the risk of hyperventilation and positive pressure ventilation.…”

Pre-hospital tracheal intubation in patients with traumatic brain injury: systematic review of current evidence

“…Both hyper-and hypocapnia may be strong components in secondary brain insult. 52 However, we emphasize that, although the effectiveness of pre-hospital intubation is uncertain, the situation may be different for other pre-hospital interventions. For instance, supplemental oxygen is recommended in recent guidelines.…”