Supplemental Oxygen Delivery to Suspected Stroke Patients in Pre Hospital and Emergency Department Settings

Overview

Journal Med Gas Res

Specialties Anesthesiology
General Medicine
Pharmacology

Date 2015 Sep 29

PMID 26413266

Citations 3

Authors

Yu-Feng Yvonne Chan

Maya Katz

Ari Moskowitz

Steven R Levine

Lynne D Richardson

Stanley Tuhrim

Kevin Chason

Kelly Barsan-Silverman

Aneesh Singhal

Affiliations

Soon will be listed here.

Abstract

Background: Recent data suggests that high-flow oxygen started promptly after stroke symptom onset salvages ischemic brain tissue. We investigated the consistency of oxygen delivery to suspected stroke patients in the pre-hospital (PH) and Emergency Department (ED) settings, and associated adverse events (AEs).

Methods: We retrospectively reviewed pre-hospital call reports of suspected stroke patients transported by our institution's paramedics. We extracted data on oxygen delivery in the PH and ED settings, demographics, Glasgow Coma Scale score (GCS), final diagnosis, and selected AEs (mortality, seizures, worsening neurological status, new infarction, and post-ischemic hemorrhage). Patients were grouped according to ED oxygen delivery: none, low-flow (2-4 L/min), and high-flow (10-15 L/min).

Results: Oxygen delivery was documented in 84% of 366 stroke transports, with 98% receiving 10-15 L/min. Our hospital received 164 patients. Oxygen delivery in the ED was documented in 150 patients, with 38% receiving none, 47% low-flow, and 15% high-flow oxygen. There were no instances of oxygen refusal, premature termination, or technical difficulties. Advanced age and low GCS predicted the use of higher flow rates. High-flow oxygen was more frequently administered to patients with symptom onset < 3 hours, and those with intracerebral hemorrhage (ICH), hypoxic-ischemic encephalopathy (HIE) or seizures (p < 0.001). More patients receiving high-flow oxygen were documented to have an AE (p = 0.02), however the low- and no-oxygen groups more frequently had multiple AEs (p = 0.01). The occurrence of AEs was predicted by the diagnosis of ICH/HIE/seizures (p = 0.013) and acute ischemic stroke (AIS)/transient ischemic attack (TIA) (p = 0.009), but not by the amount of oxygen.

Conclusions: Suspected stroke patients routinely receive 10-15 L/min oxygen in the ambulance however in the ED there is wide variability due to factors such as clinical severity. Oxygen delivery appears safe in the PH and ED settings.

Citing Articles

Physiological Variability during Prehospital Stroke Care: Which Monitoring and Interventions Are Used?.

Alshehri A, Ince J, Panerai R, Divall P, Robinson T, Minhas J Healthcare (Basel). 2024; 12(8).

PMID: 38667597 PMC: 11050416. DOI: 10.3390/healthcare12080835.

Cerebrospinal fluid oxygen optimisation for rescue of metabolically challenged in vitro cortical brain tissue.

Voss L, Whittle N, Lamber O, Envall G, Sleigh J IBRO Rep. 2020; 9:302-309.

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Hyperbaric oxygen therapy in acute stroke: is it time for Justitia to open her eyes?.

Mijajlovic M, Aleksic V, Milosevic N, Bornstein N Neurol Sci. 2020; 41(6):1381-1390.

PMID: 31925614 DOI: 10.1007/s10072-020-04241-8.

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