UK guidelines on transferring patients with brain injury and stroke patients

Takeaway

• Safe transfer of patients with acute brain trauma or stroke requires that advance agreements be in place.
• Accompanying clinician should not engage in patient care during arrival handoff.

Why this matters

• Transferring these patients carries specific risks for often avoidable poor outcomes.
• This statement incorporates research regarding, e.g., mechanical thrombectomy.

Description

• Consensus statement, updated from 2006, from Association of Anaesthetists of Great Britain and Ireland and the Neuro Anaesthesia and Critical Care Society; endorsed by 7 other British professional organizations.

What’s new

• More information on pediatric transfers.
• Suggested BPs.

Key details

• Designated consultants should coordinate transfers.
• Hospitals and ambulance services should create local agreements; autoacceptance criteria are recommended, as is a specific pathway addressing children.
• Patients requiring thrombectomy require immediate transfer.
• In children, consider nonaccidental and occult multisystem injury.
• Aim at BP targets depending on injury (table included).
• Experienced clinician should accompany patients with brain injury, but not usually those who are stable after ischemic stroke.
• Pediatric anaesthetist prepared to administer osmotherapy should ideally accompany pediatric transfers.
• Drivers transporting children should avoid rapid deceleration and acceleration.
• Upon arrival, transferring doctor should be relieved of care duties during handoff.
• Receiving team should provide refreshments to transfer team.