Ambulance deceleration causes increased intra cranial pressure in supine position: a prospective observational proof of principle study

Iscander M. Maissan*, Boris Vlottes, Sanne Hoeks, J. (Jan) Bosch, Robert Jan Stolker, Dennis den Hartog

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

2 Citations (Scopus)
9 Downloads (Pure)

Abstract

Background: Ambulance drivers in the Netherlands are trained to drive as fluent as possible when transporting a head injured patient to the hospital. Acceleration and deceleration have the potential to create pressure changes in the head that may worsen outcome. Although the idea of fluid shift during braking causing intra cranial pressure (ICP) to rise is widely accepted, it lacks any scientific evidence. In this study we evaluated the effects of driving and deceleration during ambulance transportation on the intra cranial pressure in supine position and 30° upright position.

Methods: Participants were placed on the ambulance gurney in supine position. During driving and braking the optical nerve sheath diameter (ONSD) was measured with ultrasound. Because cerebro spinal fluid percolates in the optical nerve sheath when ICP rises, the diameter of this sheath will distend if ICP rises during braking of the ambulance. The same measurements were taken with the headrest in 30° upright position.

Results: Mean ONSD in 20 subjects in supine position increased from 4.80 (IQR 4.80–5.00) mm during normal transportation to 6.00 (IQR 5.75–6.40) mm (p < 0.001) during braking. ONSD’s increased in all subjects in supine position. After raising the headrest of the gurney 30° mean ONSD increased from 4.80 (IQR 4.67–5.02) mm during normal transportation to 4.90 (IQR 4.80–5.02) mm (p = 0.022) during braking. In 15 subjects (75%) there was no change in ONSD at all.

Conclusions: ONSD and thereby ICP increases during deceleration of a transporting vehicle in participants in supine position. Raising the headrest of the gurney to 30 degrees reduces the effect of breaking on ICP.

Original languageEnglish
Article number87
JournalScandinavian Journal of Trauma, Resuscitation and Emergency Medicine
Volume29
Issue number1
Early online date30 Jul 2021
DOIs
Publication statusPublished - Dec 2021

Bibliographical note

Funding Information:
We thank Bremmer transportcollege for their hospitality, RAV Hollands Midden for the use of their ambulance and equipments, Gert Jan Stuurman and Marco Gaastra for their constant driving skills, Marcel Durieux for the prior preparations and support on the day of the experiments, Willem van ?t Leven for designing and manufacturing the mounts on the helmet.

Publisher Copyright:
© 2021, The Author(s).

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