University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA.
Howard University College of Medicine, Washington, DC, USA.
Am J Emerg Med. 2021 Dec;50:618-624. doi: 10.1016/j.ajem.2021.09.044. Epub 2021 Sep 23.
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.
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.
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).
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.
院外心脏骤停（OHCA）患者通常被送往最近的急诊部（ED）或心脏中心进行初步稳定，然后可能会转院进行进一步治疗。我们研究了在接收医院中转院延迟对院内死亡率的影响。
我们纳入了 2010 年至 2018 年期间，由单一重症监护转运服务从 ED 转运至四级医疗机构的 OHCA 患者。我们将停留时间定义为从心脏骤停到与重症监护转运团队联系的时间。我们提取了人口统计学、心脏骤停特征和转运前开始的干预措施。在主要分析中，我们使用逻辑回归来确定停留时间与院内死亡率的关系。作为次要结果，我们研究了停留时间与到达后 24 小时内死亡率、死亡患者的近因、到达时的动脉 pH 值和乳酸水平、到达后 24 小时内最差 SOFA 子量表总和以及在机构间转运过程中再次逮捕之间的关系。
我们纳入了 572 例从外部 ED 转运至我们机构的 OHCA 患者。中位停留时间为 113（IQR=85-159）分钟。以 30 分钟为一个时间区间，停留时间的增加与院内死亡率、24 小时死亡率、死亡原因和初始 pH 值无关，但与较低的 24 小时 SOFA 评分（p=0.01）和较低的初始乳酸水平（p=0.03）相关。转运过程中再次逮捕的情况很少见（n=29，5%）。停留时间与转运过程中再次逮捕的可能性较低相关（OR=0.847，95%CI 0.68-1.01，p=0.07）。
停留时间与院内死亡率无关。快速转运可能与再次逮捕的风险相关。需要前瞻性数据来阐明最佳的患者稳定和转运策略。
