The neglected prehospital phase of head injury: apnea and catecholamine surge

Mayo Clin Proc. 2000 Jan;75(1):37-47. doi: 10.4065/75.1.37.


The prehospital phase of head injury, also called the critical phase, consists of trauma-induced apnea and stress catecholamine release. This immediate period after head injury remains poorly summarized in the literature and essentially ignored with respect to treatment. A MEDLINE search of the literature on apneustic response and catecholamine surge after head injury and a review of literature from my acquired references revealed 116 references (from more than 600) that were pertinent. Apnea induced by head injury produces hypoxia, hypercarbia, and subsequent cardiac failure and hypotension, which, along with substantially elevated catecholamine values, promote secondary mechanisms of organ injury. Treatment for this immediate period after head injury requires a rapid response to the scene of trauma and development of treatment options that can be instituted at the scene of injury.

Publication types

  • Review

MeSH terms

  • Apnea / blood
  • Apnea / etiology*
  • Apnea / physiopathology
  • Blood Glucose / metabolism
  • Catecholamines / blood*
  • Craniocerebral Trauma / blood*
  • Craniocerebral Trauma / complications*
  • Craniocerebral Trauma / physiopathology
  • Craniocerebral Trauma / prevention & control
  • Hospitalization
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / etiology
  • Myocardial Infarction / etiology
  • Myocardial Infarction / physiopathology
  • Pulmonary Edema / etiology
  • Pulmonary Edema / physiopathology
  • Stomach Ulcer / etiology
  • Stomach Ulcer / physiopathology


  • Blood Glucose
  • Catecholamines