Physiological stability in patients with acute ischemic cerebral insult during the prehospital treatment phase

In patients with acute insults to the brain due to critical illness or injury (e.g. stroke, intracerebral haemorrhage, traumatic brain injury, cardiac arrest), treatment is guided by a range of physiologic treatment goals aimed at providing the best condition for brain tissue to thrive (‘neuro-protective treatment’). Such early advanced medical treatment may decrease the degree of secondary brain injury caused by exposure to hypoxia, hypotension and hypercapnia in the early phase after injury. Optimal treatment include control of blood CO2- levels within specified limits, maintaining a sufficient cerebral perfusion pressure, provide adequate sedation, optimize oxygenation, avoid fever, avoid seizures and keep serumglucose within predefined limits. Although physiologic treatment goals to optimize neuroprotective therapy are well defined, deviations from protocol have been shown to be frequent even in the intensive care unit (ICU). Previous studies on adverse physiologic events in the prehospital phase of treatment have demonstrated such deviations as frequent, but no studies have yet applied continuous measurements of physiologic variables to assess the magnitude of adverse physiologic exposure during prehospital emergency therapy. This project aims to collect high-resolution physiologic data in critical ill or injured patients, collected by multi-function monitors, in patients treated by the Helicopter Emergency Medical Service (HEMS) in Trondheim, Norway. The main research question addressed in this study will be to what extent deviations from physiologic treatment goals are present in the prehospital phase and early in-hospital phase of treatment in patients with acute ischemic insults to the brain.