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Three Part Question

1) In [polytrauma patients who have haemorrhagic injuries to the trunk alongside a traumatic brain injury, current Ambulance Service guidelines recommend maintaining permissive hypotension]
2) Are [these guidelines in conflict with all published literature stating the importance of keeping SBP >90mmHg at all times]
3) In [anyone with a TBI, regardless of other injuries]?

Clinical Scenario

Polytrauma patients with penetrating trunk injuries alongside a TBI would be treated by the Ambulance Service anywhere in the UK and that crew would follow clinical treatment guidance published by the Association of Ambulance Chief Executives and Joint Royal Colleges Ambulance Liaison Committee (JRCALC). In this scenario JRCALC would suggest maintaining permissive hypotension despite all of the evidence maintaining that one drop in systolic blood pressure below 90mmHg in a TBI patient leads to as much as a 100% increase in mortality.

Search Strategy

Collected articles from various sources over the past three years. Used the Anglia Ruskin University Library website to conduct various searches over the past three years. Ovid MEDLINE(R) ALL 1946 to 2021.

(Traumatic brain injury + hypotension + secondary brain injury) NOT children.

Search Outcome

28 papers alongside others collected over the years through personal interest.

Comment(s)

National Ambulance Service Clinical guidelines require updating in line with evidence. A large and important patient group of adults are being incorrectly treated. New research by Spaite, et al. (2019) further supports previous findings and dispels concerns about the perils of over-infusion of normal saline to polytrauma patients with concurrent TBI.

Clinical Bottom Line

National Ambulance Service guidelines are poor and need revision.