Impact Brain Apnoea

For those who suffer head injury, the cause of morbidity and mortality is much more complex than previously thought, but paradoxically, perhaps much more straightforward to treat.

After a knock on the head, it is becoming clear that some patients do not breathe normally. In fact, some patients do not breathe at all. Other patients stop breathing and then start again if they are stimulated, or given assistance with their breathing. This all happens without the brain cells and connections being injured as part of the impact itself. The brain cells and connections are only injured in these cases by the effects of hypoxia, or lack of oxygen, when the breathing system is damaged.

If help is given to these head-injured patients, and their breathing is supported then they can recover completely. Therefore, in a pure impact brain apnoea model, all that needs to be done is for someone, perhaps a bystander to intervene and help the person breathe. This can be done by simply turning a patient on their side, or on their front, or by lifting their jaw to open their airway.

In 2016 we published a paper revisiting the concept of impact brain apnoea.

It is clear that the approach of bystanders and those in attendance very quickly after someone has sustained a head injury are crucial in improving the survival chances in such patients. Technology such as the GoodSam app are vital here, as are the actions of staff in the ambulance service control room, who can give instructions to bystanders on how to help.

Pure impact apnoea models are relatively rare, but it is clear that many head injured patients suffer from the effects of hypoxia. Sadly, this is often in the context of intracranial bleeding, traumatic axonal injury, and those pathologies that are rather more difficult to treat at the roadside. The phase of hyperacute head injury (the phase immediately following an impact to the head) requires much more research, and our head injury research fellow will help us make progress on this in the months and years to come.