Supplemental oxygen delivery to suspected stroke patients in pre hospital and emergency department settings

BACKGROUND: Recent data suggests that high-flow oxygen started promptly after stroke symptom onset salvages ischemic brain tissue. We investigated the consistency of oxygen delivery to suspected stroke patients in the pre-hospital (PH) and Emergency Department (ED) settings, and associated adverse events (AEs). METHODS: We retrospectively reviewed pre-hospital call reports of suspected stroke patients transported by our institution’s paramedics. We extracted data on oxygen delivery in the PH and ED settings, demographics, Glasgow Coma Scale score (GCS), final diagnosis, and selected AEs (mortality, seizures, worsening neurological status, new infarction, and post-ischemic hemorrhage). Patients were grouped according to ED oxygen delivery: none, low-flow (2-4 L/min), and high-flow (10-15 L/min). RESULTS: Oxygen delivery was documented in 84% of 366 stroke transports, with 98% receiving 10-15 L/min. Our hospital received 164 patients. Oxygen delivery in the ED was documented in 150 patients, with 38% receiving none, 47% low-flow, and 15% high-flow oxygen. There were no instances of oxygen refusal, premature termination, or technical difficulties. Advanced age and low GCS predicted the use of higher flow rates. High-flow oxygen was more frequently administered to patients with symptom onset < 3 hours, and those with intracerebral hemorrhage (ICH), hypoxic-ischemic encephalopathy (HIE) or seizures (p < 0.001). More patients receiving high-flow oxygen were documented to have an AE (p = 0.02), however the low- and no-oxygen groups more frequently had multiple AEs (p = 0.01). The occurrence of AEs was predicted by the diagnosis of ICH/HIE/seizures (p = 0.013) and acute ischemic stroke (AIS)/transient ischemic attack (TIA) (p = 0.009), but not by the amount of oxygen. CONCLUSIONS: Suspected stroke patients routinely receive 10–15 L/min oxygen in the ambulance however in the ED there is wide variability due to factors such as clinical severity. Oxygen delivery appears safe in the PH and ED settings.