AEROMEDICAL PREHOSPITAL NEUROTRAUMA CARE AND SECONDARY SYSTEMIC INSULTS TO THE INJURED BRAIN

Advanced supportive therapy at the site of the accident, associated wi th direct transfer to a trauma centre increases survival and reduces m orbidity rates. Patients with severe head injury, especially those wit h multiple injuries, often arrive in the emergency department with pot entially causes of serious secondary systemic insults to the already i njured brain, such as acute anemia (Hematocrit less-than-or-equal-to 3 0%), hypotension (systolic arterial pressure (Pa(sys)) less-than-or-eq ual-to 95 mmHg, 12,7 kPa), hypercapnia (Paco2 greater-than-or-equal-to 45 mmHg, 6 kPa) and/or hypoxemia (Pao2 less-than-or-equal-to 65 mmHg, 8,7 kPa). The incidence of such insults and their impact on mortality were studied in a group of 51 consecutive adults suffering from non p enetrating severe head injury (Glasgow score less-than-or-equal-to 8, mean age 31 +/- 17 yrs) rescued by a medicalised helicopter. Each pati ent received medical care on the site of the accident by an anaesthesi ologist of a university hospital (UH) complying with an advanced traum a life support protocol including intubation, hyperventilation with FI O2 = 1, restoration of an adequate Pa(sys) and direct transportation t o the UH. Mean delay from call to arrival of the rescue team on the si te was 15 +/- 5 min. Mean scene time was 32 +/- 10 min in cases not re quiring extrication. Nineteen patients (Group I) were admitted without secondary systemic insults to the brain, 13 with isolated head injury , and 6 with multiple injuries, with a low Glasgow Outcome Score (GOS 1-3) of 42 % at 3 months. In 32 patients (Group II), despite advanced supportive measures a the scene of the accident and during transportat ion, one or more secondary systemic insults to the brain were detected upon arrival at the emergency room, one with isolated head injury, 31 with multiple injuries, with a bad GOS of 72 % at 3 months. We conclu de that : 1) advanced trauma life support prevents from secondary syst emic insults in the great majority of isolated severe head injured pat ients, 2) secondary systemic insults to the already injured brain are frequent in patients with multiple injuries and are difficult to avoid despite rapid aeromedical trauma care, 3) secondary systemic insults to the brain have a catastrophic impact on the outcome of severely hea d injured patients.