Prehospital on-scene anesthetist treatment improves outcomes for individuals with severe traumatic brain injury

Traumatic brain injury (TBI) is a common cause of death and disability worldwide. An estimated 10-20% of TBIs are moderate or severe, and individuals with severe injuries are at approximately 50% risk of dying or experiencing disability as a result. Intensive care unit treatment is almost always necessary for people who sustain a moderate or severe TBI, but prehospital assessment and treatment is also a critical component of the medical care process. Although the prognosis of patients with severe TBI is strongly dependent on early support of vital signs, currently there is little research on advanced prehospital interventions.

To address this gap, a team of researchers studied the possible benefit of on-scene anesthetist treatment for individuals with severe TBI, which is defined by a Glasgow Coma Score (GCS) equal to or greater than 8. They hypothesized that early intervention from an anesthetist, a registered nurse trained to safely administer anesthesia, would decrease mortality and improve long-term neurological outcomes for severe TBI patients. Anesthetists use methods such as airway control and ventilation to ensure that severely injured patients receive enough oxygen.

The research team found that 97% of patients received successful airway management when an anesthetist was present at the scene of the injury. Only 16% of patients received successful airway management when the anesthetist was not present. In general, patients who were treated by an anesthetist at the scene were more likely to survive their TBI. They were also more likely to experience good neurological outcomes during the injury recovery period.

Individuals who experience severe TBI are at high risk for death and disability. Fortunately, immediate life-saving interventions can increase the chance of survival and rehabilitation. On-scene anesthetic treatment optimizes the transit time between the injury scene and the hospital, providing a promising care option for individuals with severe TBI.

Pakkanen T, Nurmi J, Huhtala H, et al. Prehospital on-scene anaesthetist treating severe traumatic brain injury patients is associated with lower mortality and better neurological outcome. Scandinavian Journal of Trauma, Resuscitation, and Emergency Medicine. (January 2019).
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