Department of Intensive Care, Alfred Health, Melbourne, Victoria, Australia.
Ambulance Victoria, Blackburn, Victoria, Australia.
Shock. 2022 Sep 1;58(3):204-210. doi: 10.1097/SHK.0000000000001974. Epub 2022 Aug 26.
Background: Regionalized systems of care for the management of cardiogenic shock (CS) are increasingly being utilized. This study aims to assess whether receiving hospital characteristics such as the availability of 24-hour coronary angiography, on-site cardiac surgery, and annual treated CS volume influence outcomes in patients transferred by emergency medical services (EMS) to hospital with CS. Methods: This population-based cohort study included consecutive adult patients with CS who were transferred to hospital by EMS between January 1, 2015 and June 30, 2019 in Victoria, Australia. Data were obtained from individually linked ambulance, hospital, and state death index data sets. The primary outcome assessed was 30-day mortality stratified by the availability of 24-hour coronary angiography (cardiac center) at the receiving hospital. Results: A total of 3,217 patients were transferred to hospital with CS. The population had an average age of 67.9 +/- 16.1 years, and 1,289 (40.1%) were female. EMS transfer to a cardiac center was associated with significantly reduced rates of 30-day mortality (adjusted odds ratio [aOR], 0.78; 95% confidence interval [CI], 0.64-0.95), compared with noncardiac centers. Compared with the lowest annual CS volume quartile (<18 cases per year), hospitals in the highest volume quartile (>55 cases per year) had reduced risk of 30-day mortality (aOR, 0.71; 95% CI, 0.56-0.91). A stepwise reduction in the adjusted probability of 30-day mortality was observed in patients transferred by EMS to trauma level 1 centers (34.6%), compared with cardiothoracic surgical centers (39.0%), noncardiac surgical metropolitan (44.9%), and rural (51.3%) cardiac centers, all P < 0.05. Conclusion: Receiving hospital characteristics are associated with survival outcomes in patients with CS. These finding have important implications for establishing regionalized systems of care for patients with CS who are transferred to hospital by EMS.
为管理心源性休克（CS）而建立的区域性医疗系统越来越多地被应用。本研究旨在评估患者通过紧急医疗服务（EMS）转至 CS 医院时，接收医院的特征（如 24 小时冠状动脉造影、现场心脏手术和每年治疗 CS 的容量）是否会影响患者的结局。
本基于人群的队列研究纳入了 2015 年 1 月 1 日至 2019 年 6 月 30 日期间，通过 EMS 转至澳大利亚维多利亚州 CS 医院的连续成年 CS 患者。数据来自个体链接的救护车、医院和州死亡指数数据集。主要结局评估是根据接收医院是否有 24 小时冠状动脉造影（心脏中心）而分层的 30 天死亡率。
共 3217 例 CS 患者通过 EMS 转至医院。该人群的平均年龄为 67.9 +/- 16.1 岁，其中 1289 例（40.1%）为女性。与非心脏中心相比，EMS 转至心脏中心的 30 天死亡率显著降低（调整后优势比 [aOR]，0.78；95%置信区间 [CI]，0.64-0.95）。与每年 CS 量最低的四分位数（<18 例/年）相比，年 CS 量最高的四分位数（>55 例/年）的医院 30 天死亡率降低（aOR，0.71；95%CI，0.56-0.91）。与创伤 1 级中心（34.6%）相比，通过 EMS 转至心胸外科中心（39.0%）、非心脏外科大都市（44.9%）和农村（51.3%）心脏中心的患者，其 30 天死亡率的调整概率呈逐步降低趋势，所有 P < 0.05。
接收医院的特征与 CS 患者的生存结局相关。这些发现对为通过 EMS 转至医院的 CS 患者建立区域性医疗系统具有重要意义。
