{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T22:26:19Z","timestamp":1791584779157,"version":"4.3.4"},"reference-count":23,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,19]],"date-time":"2021-12-19T00:00:00Z","timestamp":1639872000000},"content-version":"unspecified","delay-in-days":18,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,11,26]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Prehospital rapid sequence induction (RSI) of anaesthesia is an intervention with significant associated risk. In this study, we aimed to investigate the haemodynamic response over time of a prehospital RSI protocol of fentanyl, ketamine and rocuronium in a heterogeneous population of trauma patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, setting and participant<\/jats:title>\n                    <jats:p>We performed a retrospective study of all trauma patients who received a prehospital RSI for trauma by a physician staffed Helicopter Emergency Medical Service in the UK between 1 June 2018 and 1 February 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measure<\/jats:title>\n                    <jats:p>Primary outcome was defined as the incidence of clinically relevant hypotensive (systolic blood pressure (SBP) or mean arterial pressure (MAP) &gt;20% below baseline, with an absolute SBP &lt;90\u2009mm Hg or MAP &lt;65\u2009mm Hg) or hypertensive (SBP or MAP &gt;20% above baseline) episodes in the first 10 minutes post-RSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In total, 322 patients were included. 204 patients (63%) received a full-dose induction of 3 \u03bcg\/kg fentanyl, 2\u2009mg\/kg ketamine and 1\u2009mg\/kg rocuronium, whereas 128 patients (37%) received a reduced-dose induction. Blood pressures decreased on average 12\u2009mm Hg (95%\u2009CI 7 to 16) in the full-dose group and 6\u2009mm Hg (95%\u2009CI 1 to 11) in the reduced-dose group, p=0.10). A hypotensive episode (mean SBP drop 53\u2009mm Hg) was noted in 29 patients: 17 (8.3%) receiving a full dose and 12 (10.2%) receiving a reduced-dose induction, p=0.69. The blood pressure nadir was recorded on average 6\u20138\u2009min after RSI. A hypertensive episode was present in 22 patients (6.8%). The highest blood pressures were recorded in the first 3\u2009min after RSI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prehospital induction of anaesthesia for trauma with fentanyl, ketamine and rocuronium is not related to a significant change in haemodynamics in most patients. However, a (delayed) hypotensive response with a significant drop in SBP should be anticipated in a minority of patients irrespective of the dose regimen chosen.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-056487","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T13:49:59Z","timestamp":1640008199000},"page":"e056487","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":17,"title":["Haemodynamic effects of a prehospital emergency anaesthesia protocol consisting of fentanyl, ketamine and rocuronium in patients with trauma: a retrospective analysis of data from a Helicopter Emergency Medical Service"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1462-6130","authenticated-orcid":false,"given":"Ewoud","family":"ter Avest","sequence":"first","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"},{"name":"Emergency Medicine, University Medical Centre Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dassen","family":"Ragavan","sequence":"additional","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joanne","family":"Griggs","sequence":"additional","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"},{"name":"University of Surrey, Guildford, Surrey, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Dias","sequence":"additional","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophie A","family":"Mitchinson","sequence":"additional","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Lyon","sequence":"additional","affiliation":[{"name":"Air Ambulance Kent Surrey and Sussex, Redhill, Surrey, UK"},{"name":"School of Health Sciences, University of Surrey, Guildford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,12,20]]},"reference":[{"key":"2025121411554615000_11.12.e056487.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.2011.06931.x"},{"key":"2025121411554615000_11.12.e056487.2","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aes393"},{"key":"2025121411554615000_11.12.e056487.3","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aer251"},{"key":"2025121411554615000_11.12.e056487.4","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2021.1727"},{"key":"2025121411554615000_11.12.e056487.5","doi-asserted-by":"publisher","DOI":"10.1136\/emermed-2017-206592"},{"key":"2025121411554615000_11.12.e056487.6","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu205"},{"key":"2025121411554615000_11.12.e056487.7","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-014-0041-7","article-title":"Development of a standard operating procedure and checklist for rapid sequence induction in the critically ill","volume":"22","author":"Sherren","year":"2014","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2025121411554615000_11.12.e056487.8","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-018-0554-6","article-title":"Best practice advice on pre-hospital emergency anaesthesia & advanced airway management","volume":"27","author":"Crewdson","year":"2019","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2025121411554615000_11.12.e056487.9","doi-asserted-by":"crossref","unstructured":"Gawande A . The checklist manifesto: how to get things right. New York: Metropolitan Books, 2010.","DOI":"10.1016\/S2155-8256(15)30310-0"},{"key":"2025121411554615000_11.12.e056487.10","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-015-0872-2"},{"key":"2025121411554615000_11.12.e056487.11","doi-asserted-by":"publisher","DOI":"10.1136\/jrnms-103-111"},{"key":"2025121411554615000_11.12.e056487.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"2025121411554615000_11.12.e056487.13","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000175214.38450.91"},{"key":"2025121411554615000_11.12.e056487.14","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aex127"},{"key":"2025121411554615000_11.12.e056487.15","first-page":"e9","article-title":"The frequency and significance of post-intubation hypotension during emergency airway management","volume":"27","author":"Hefner","year":"2012","journal-title":"J Crit Care"},{"key":"2025121411554615000_11.12.e056487.16","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1097\/MEJ.0000000000000103","article-title":"Anaesthesiologist-provided prehospital airway management in patients with traumatic brain injury: an observational study","volume":"21","author":"Rogn\u00e5s","year":"2014","journal-title":"Eur J Emerg Med"},{"key":"2025121411554615000_11.12.e056487.17","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1097\/00000542-199902000-00034","article-title":"A review of the use of fentanyl analgesia in the management of acute pain in adults","volume":"90","author":"Peng","year":"1999","journal-title":"Anesthesiology"},{"key":"2025121411554615000_11.12.e056487.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2012.03.019"},{"key":"2025121411554615000_11.12.e056487.19","doi-asserted-by":"crossref","first-page":"1090","DOI":"10.1111\/j.1365-2044.2001.01962.x","article-title":"Rapid sequence induction: a national survey of practice","volume":"56","author":"Morris","year":"2001","journal-title":"Anaesthesia"},{"key":"2025121411554615000_11.12.e056487.20","doi-asserted-by":"crossref","first-page":"1074","DOI":"10.1097\/TA.0b013e3182827305","article-title":"The relationship between head injury severity and hemodynamic response to tracheal intubation","volume":"74","author":"Perkins","year":"2013","journal-title":"J Trauma Acute Care Surg"},{"key":"2025121411554615000_11.12.e056487.21","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1111\/aas.13309","article-title":"Fentanyl or placebo with ketamine for emergency department rapid sequence intubation: the FAKT study protocol","volume":"63","author":"Ferguson","year":"2019","journal-title":"Acta Anaesthesiol Scand"},{"key":"2025121411554615000_11.12.e056487.22","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1080\/10903127.2018.1448494","article-title":"Analysis of prehospital scene times and interventions on mortality outcomes in a national cohort of penetrating and blunt trauma patients","volume":"22","author":"Ruelas","year":"2018","journal-title":"Prehosp Emerg Care"},{"key":"2025121411554615000_11.12.e056487.23","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1111\/aas.13059","article-title":"Prehospital emergency anaesthesia in awake hypotensive trauma patients: beneficial or detrimental?","volume":"62","author":"Crewdson","year":"2018","journal-title":"Acta Anaesthesiol Scand"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2021-056487","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T19:55:52Z","timestamp":1765742152000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2021-056487"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12]]},"references-count":23,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2021,12,20]]},"published-print":{"date-parts":[[2021,12]]}},"alternative-id":["10.1136\/bmjopen-2021-056487"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2021-056487","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12]]}}}