Time to specialty care and mortality after cardiac arrest
| Autor: | Kaia Amoah, Katharyn L Flickinger, Joseph P Condle, Patrick J Coppler, Clifton W. Callaway, Onaje Artist, Eva V. Zadorozny, Francis X. Guyette, Jonathan Elmer, Azmina Mohammed, Christian Martin-Gill |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Patient Transfer medicine.medical_specialty Critical Care Specialty Logistic regression Time-to-Treatment medicine Humans Arterial pH Hospital Mortality Aged Retrospective Studies Cause of death business.industry General Medicine Rearrest Emergency department Middle Aged Survival Rate Dwell time Logistic Models Transportation of Patients Emergency medicine Emergency Medicine Female SOFA score Emergency Service Hospital business Out-of-Hospital Cardiac Arrest |
| Zdroj: | The American Journal of Emergency Medicine. 50:618-624 |
| ISSN: | 0735-6757 |
| Popis: | Introduction Out of hospital cardiac arrest (OHCA) patients are often transported to the closest emergency department (ED) or cardiac center for initial stabilization and may be transferred for further care. We investigated the effects of delay to transfer on in hospital mortality at a receiving facility. Methods We included OHCA patients transported from the ED by a single critical care transport service to a quaternary care facility between 2010 and 2018. We calculated dwell time as time from arrest to critical care transport team contact. We abstracted demographics, arrest characteristics, and interventions started prior to transport arrival. For the primary analysis, we used logistic regression to determine the association of dwell time and in-hospital mortality. As secondary outcomes we investigated for associations of dwell time and mortality within 24 h of arrival, proximate cause of death among decedents, arterial pH and lactate on arrival, sum of worst SOFA subscales within 24 h of arrival, and rearrest during interfacility transport. Results We included 572 OHCA patients transported from an outside ED to our facility. Median dwell time was 113 (IQR = 85–159) minutes. Measured in 30 min epochs, increasing dwell time was not associated with in-hospital mortality, 24-h mortality, cause of death and initial pH, but was associated with lower 24-h SOFA score (p = 0.01) and lower initial lactate (p = 0.03). Rearrest during transport was rare (n = 29, 5%). Dwell time was associated with lower probability of rearrest during transport (OR = 0.847, (95% CI 0.68–1.01), p = 0.07). Conclusions Dwell time was not associated with in-hospital mortality. Rapid transport may be associated with risk of rearrest. Prospective data are needed to clarify optimal patient stabilization and transport strategies. |
| Databáze: | OpenAIRE |
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