Department of Paramedicine, Monash University, Melbourne, Victoria, Australia.
Ambulance Victoria, Barwon, Victoria, Australia.
Emerg Med Australas. 2021 Feb;33(1):94-99. doi: 10.1111/1742-6723.13594. Epub 2020 Aug 9.
Rapid sequence intubation (RSI) is used to secure the airway of some patients with stroke. Recent observational studies suggest that RSI is associated with poorer survival, and that decreases in systolic blood pressure (BP) following RSI could be a cause of worse survival. The present study aims to find if decreased systolic BP after paramedic RSI is associated with poorer survival in stroke patients transported by ambulance.
The present study was a retrospective analysis of all stroke patients who received paramedic RSI attended by Ambulance Victoria, Australia. Logistic regression predicted the survival for strokes that had received RSI. The change in systolic BP during paramedic care was the main predictor.
Of 43 831 patients with stroke, 882 (2%) received RSI. Almost 48% of RSI had a decline in systolic BP of more than 20% from baseline, and the decline in systolic BP after RSI was largest for intra-cerebral haemorrhage (-22.7 mmHg) compared to ischaemic strokes (-10.1 mmHg) or subarachnoid haemorrhage (-15.6 mmHg) (P = 0.001). Sixteen percent of the RSI group had an episode of hypotension anytime during the out-of-hospital care. For each 10 mmHg decrease in systolic BP with RSI for intra-cerebral haemorrhage an increase of 11% in the odds of survival is apparent (P = 0.04); for subarachnoid haemorrhage an increase of 17% (P = 0.02) and for ischaemic strokes a non-significant decrease of 7% (P = 0.26).
Paramedic RSI-related decrease in systolic BP is associated with improved survival in those with intra-cerebral or subarachnoid haemorrhage but not ischaemic stroke.
对一些中风患者进行快速序贯插管（RSI）以确保其气道畅通。最近的观察性研究表明，RSI 与生存率降低有关，而 RSI 后收缩压（BP）下降可能是导致生存率降低的原因。本研究旨在探讨中风患者在接受 RSI 后，其在急救护理期间收缩压下降与生存率之间的关系。
本研究为回顾性分析，纳入了澳大利亚维多利亚救护车服务中心接受过急救人员 RSI 的所有中风患者。采用逻辑回归预测接受 RSI 的中风患者的生存率。收缩压的变化是主要的预测指标。
在 43831 名中风患者中，有 882 名（2%）接受了 RSI。几乎有 48%的 RSI 患者收缩压从基线下降超过 20%，与缺血性中风（-10.1mmHg）或蛛网膜下腔出血（-15.6mmHg）相比，脑出血患者 RSI 后收缩压下降幅度最大（-22.7mmHg）（P=0.001）。RSI 组中有 16%的患者在院外护理期间出现任何时间的低血压。对于脑出血患者，RSI 每下降 10mmHg 收缩压，生存率的比值比增加 11%（P=0.04）；蛛网膜下腔出血患者增加 17%（P=0.02），缺血性中风患者无显著下降 7%（P=0.26）。
与 RSI 相关的收缩压下降与脑出血或蛛网膜下腔出血患者的生存率提高有关，但与缺血性中风患者无关。
