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The association of paramedic rapid sequence intubation and survival in out-of-hospital stroke
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  • Published on:
    Rapid sequence intubation (RSI) is uncommon in prehospital stroke care
    • Josephine M E Gibson, Reader in Health Services Research; Senior Research Fellow University of Central Lancashire; NIHR Collaboration for Leadership in Applied Health Research and Care, North West Coast
    • Other Contributors:
      • Stephanie P Jones, Senior Research Fellow
      • Caroline L Watkins, Professor of Stroke and Older People's Care

    As researchers with an interest in pre-hospital stroke care, we read this paper with interest, but also with some surprise at the authors’ assertion that ‘RSI is commonly used by paramedics in stroke’. On examining the cited studies and the authors’ own findings more closely, this statement is hard to justify. Although Meyer et al did indeed report that 55% of out-of-hospital haemorrhagic strokes received RSI, this actually refers to a retrospective chart review of 20 children, all of whom with a Glasgow Coma Scale ≤ 8 following acute haemorrhagic stroke from a cerebral arteriovenous malformation rupture. This small, selective paediatric sample cannot be held to be representative of all stroke patients who are conveyed to hospital by emergency medical services. The other study cited as evidence found that people with acute stroke form a substantial proportion (36.6%) of RSIs undertaken by paramedics (Fouche et al., 2017). Whilst stroke may be a common reason for paramedic RSI, it cannot therefore be inferred that paramedic RSI is common in stroke. The authors’ own findings bear this out: of their sample of nearly 44,000 stroke patients conveyed by the emergency medical services, only 2% had received paramedic RSI.

    Whilst we congratulate the authors on their comprehensive analysis of this large dataset, it is important that readers do not gain the impression that paramedic RSI is frequently indicated and performed in pre-hospital stroke care.

    Disclaimer: JG an...

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    Conflict of Interest:
    None declared.