Prolonged Transport of Patients After Out-hospital Cardiac Arrest (OHCA) Primarily to Regional Cardiac Arrest Center (CAC) Doesn`t Affect Initial Hemodynamic Parameters and Outcomes

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RIV/27283933:_____/18:00006562

Výsledek na webu

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DOI - Digital Object Identifier

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Jazyk výsledku

angličtina

Název v původním jazyce

Prolonged Transport of Patients After Out-hospital Cardiac Arrest (OHCA) Primarily to Regional Cardiac Arrest Center (CAC) Doesn`t Affect Initial Hemodynamic Parameters and Outcomes

Popis výsledku v původním jazyce

Introduction: Systematic care of patients after OHCA and developement of CAC is recommended by the guidelines, but important "contra" argument iss prolonged transport of often hemodynamicly unstable patients in limited prehospital emergency care. Aim: To determine if prolonged primarily transport of patients after OHCA to regional CAC influence initial hemodynamic parameters after admission, mortality a neurtological outcome. Methods: Analysis from prospective OHCA Registry of regional CAC from 2013 to 2017. Data were divided into 2 datasets: 1) INSIDE - when CAC is the nearest hospital and 2) OUTSIDE - patients transfered to CAC, but in past would be transferred to one of the 7 another closer hospitals in the region. We observed duration of transport, baseline characteristics (age, gender, bystander CPR, ROSC, shockable rhythm, acute coronary syndromes (ACS), catecholamins administration during transfer), hemodynamic parameters on arrival to hospital (systolic BP lactate, pH, SpO2, body temperature and initial doses of vasopressors and inotropics) and final outcomes (30 - day/in hospital mortality, length of ICU stay, artificial ventilation days, 1 year CPC). Results: 232 patients were enrolled after OHCA in years 2013 to 2017, 27 were excluded for insuficient data and 19 for secondary transfer to CAC. We analyzed 186 patients, 93 in both groups. We observed no differences in baseline characteristics in both groups: men (66,7% vs. 80,6%, p=0.29), age (64,51 /- 1,324 years vs 61,25 /- 1,443 years, p=0.1), shockable rhythm (65,6% vs. 74,2%, p=0.26), bystander CPR (68,8% vs. 72%, p=0.75), ROSC (median, IQR):17 (11-26) min vs. 20 (15-30) minutes, p=0.29,ACS )44,1% vs. 48,4%, p=0.66) and catecholamine administration during transfer (80% vs. 70%, p=0.18). We observed no differences in initial hemodynamic parameters in time of admission in both groups. Systolic blood pressure: (median, IQR): 103 (82-120) vs. 105 (82-124) mm Hg, p=0.6, serum lactate level (median, IQR): 4.6 (2-8.1) vs. 3.5 (2-6.75) mmo/l, p=0.372, pH (median, IQR): 7.242 (7.122-7.322) vs 7.286 (7.177-7.318), p=0.159, body temperature: (median, IQR): 35.95 (35.08-36.5) vs 36 35.5-36.5), p=0.218 and oxygen saturation (SpO2):(median, IQR): 95 (91-100) vs. 98 (94-100), p=0.14. We observed no differences in catecholamins dosages. Norepinephrine (7.54 - 1.75 vs. 5.98 -1.17 mcg/min), p=0.46 and dobutamine (66.31 -45.81 vs. 38.6 -15.62 mcg/min), p=0.56. There was no significant difference in in-hospital/30-day mortality between groups (44.1% vs.42.3%, p=0.88). 1-year good neurological outcome (CPC 1,2) was identical (54,2% vs 54,2, p=0.999). Median of artificial ventilation duration was without significant difference: (median/IQR) 3 (1-8) vs. 5 (1-7.75) days, p=0.36 and median of length of ICU stay was without significant difference: (median/IQR) 6 (2-14.75) vs. 7(3-12) days, p=0.74. Conclusion: Strategy of primary transport of patients after OHCA to CAC significantly prolonged time of transport, but didn`t affect hemodynamic parameters and outcome of patients.

Název v anglickém jazyce

Prolonged Transport of Patients After Out-hospital Cardiac Arrest (OHCA) Primarily to Regional Cardiac Arrest Center (CAC) Doesn`t Affect Initial Hemodynamic Parameters and Outcomes

Popis výsledku anglicky

Introduction: Systematic care of patients after OHCA and developement of CAC is recommended by the guidelines, but important "contra" argument iss prolonged transport of often hemodynamicly unstable patients in limited prehospital emergency care. Aim: To determine if prolonged primarily transport of patients after OHCA to regional CAC influence initial hemodynamic parameters after admission, mortality a neurtological outcome. Methods: Analysis from prospective OHCA Registry of regional CAC from 2013 to 2017. Data were divided into 2 datasets: 1) INSIDE - when CAC is the nearest hospital and 2) OUTSIDE - patients transfered to CAC, but in past would be transferred to one of the 7 another closer hospitals in the region. We observed duration of transport, baseline characteristics (age, gender, bystander CPR, ROSC, shockable rhythm, acute coronary syndromes (ACS), catecholamins administration during transfer), hemodynamic parameters on arrival to hospital (systolic BP lactate, pH, SpO2, body temperature and initial doses of vasopressors and inotropics) and final outcomes (30 - day/in hospital mortality, length of ICU stay, artificial ventilation days, 1 year CPC). Results: 232 patients were enrolled after OHCA in years 2013 to 2017, 27 were excluded for insuficient data and 19 for secondary transfer to CAC. We analyzed 186 patients, 93 in both groups. We observed no differences in baseline characteristics in both groups: men (66,7% vs. 80,6%, p=0.29), age (64,51 /- 1,324 years vs 61,25 /- 1,443 years, p=0.1), shockable rhythm (65,6% vs. 74,2%, p=0.26), bystander CPR (68,8% vs. 72%, p=0.75), ROSC (median, IQR):17 (11-26) min vs. 20 (15-30) minutes, p=0.29,ACS )44,1% vs. 48,4%, p=0.66) and catecholamine administration during transfer (80% vs. 70%, p=0.18). We observed no differences in initial hemodynamic parameters in time of admission in both groups. Systolic blood pressure: (median, IQR): 103 (82-120) vs. 105 (82-124) mm Hg, p=0.6, serum lactate level (median, IQR): 4.6 (2-8.1) vs. 3.5 (2-6.75) mmo/l, p=0.372, pH (median, IQR): 7.242 (7.122-7.322) vs 7.286 (7.177-7.318), p=0.159, body temperature: (median, IQR): 35.95 (35.08-36.5) vs 36 35.5-36.5), p=0.218 and oxygen saturation (SpO2):(median, IQR): 95 (91-100) vs. 98 (94-100), p=0.14. We observed no differences in catecholamins dosages. Norepinephrine (7.54 - 1.75 vs. 5.98 -1.17 mcg/min), p=0.46 and dobutamine (66.31 -45.81 vs. 38.6 -15.62 mcg/min), p=0.56. There was no significant difference in in-hospital/30-day mortality between groups (44.1% vs.42.3%, p=0.88). 1-year good neurological outcome (CPC 1,2) was identical (54,2% vs 54,2, p=0.999). Median of artificial ventilation duration was without significant difference: (median/IQR) 3 (1-8) vs. 5 (1-7.75) days, p=0.36 and median of length of ICU stay was without significant difference: (median/IQR) 6 (2-14.75) vs. 7(3-12) days, p=0.74. Conclusion: Strategy of primary transport of patients after OHCA to CAC significantly prolonged time of transport, but didn`t affect hemodynamic parameters and outcome of patients.

Druh

O - Ostatní výsledky

CEP obor

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OECD FORD obor

30201 - Cardiac and Cardiovascular systems

Projekt

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Návaznosti

I - Institucionalni podpora na dlouhodoby koncepcni rozvoj vyzkumne organizace

Rok uplatnění

2018

Kód důvěrnosti údajů

S - Úplné a pravdivé údaje o projektu nepodléhají ochraně podle zvláštních právních předpisů