Abstract
Objective
Early death following cranial trauma is often considered unsurvivable traumatic brain
injury (TBI). However, Impact Brain Apnoea (IBA), the phenomenon of apnoea following
TBI, may be a significant and preventable contributor to death attributed to primary
injury. This paper reviews the history of IBA, cites case examples and reports a survey
of emergency responder experience.
Methods
Literature and narrative review and focused survey of pre-hospital physicians.
Results
IBA was first reported in the medical literature in 1705 but has been demonstrated
in multiple animal studies and is frequently anecdotally witnessed in the pre-hospital
arena following human TBI. It is characterised by the cessation of spontaneous breathing
following a TBI and is commonly accompanied by a catecholamine surge witnessed as
hypertension followed by cardiovascular collapse. This contradicts the belief that
isolated traumatic brain injury cannot be the cause of shock, raising the possibility
that brain injury may be misinterpreted and therefore mismanaged in patients with
isolated brain injury. Current trauma management techniques (e.g. rolling patients
supine, compression only cardiopulmonary resuscitation) could theoretically compound
hypoxia and worsen the effects of IBA. Anecdotal examples from clinicians attending
head injured patients within a few minutes of injury are described. Proposals for
the study and intervention for IBA using advances in remote technology are discussed.
Conclusion
IBA is a potential cause of early death in some head injured patients. The precise
mechanisms in humans are poorly understood but it is likely that early, simple interventions
to prevent apnoea could improve clinical outcomes.
Keywords
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Article info
Publication history
Published online: May 19, 2016
Accepted:
May 5,
2016
Received in revised form:
February 20,
2016
Received:
December 20,
2015
Identification
Copyright
© 2016 Published by Elsevier Ireland Ltd.
