COVID-19 大流行对西班牙四个地区的卒中急救单元进行的高级生命支持的院外管理的影响：一项观察性研究。
Effect of the COVID-19 pandemic on advanced life support units' prehospital management of the stroke code in four Spanish regions: an observational study.
机构信息
Servicio de Urgencias Médicas de Madrid (SUMMA-112), Madrid, Spain.
Córdoba Provincial Service. Centro de Emergencias Sanitarias 061 (CES 061), Córdoba, Spain.
出版信息
BMC Emerg Med. 2023 Oct 4;23(1):116. doi: 10.1186/s12873-023-00886-8.
INTRODUCTION
Stroke is the most common time-dependent pathology that pre-hospital emergency medical services (EMS) are confronted with. Prioritisation of ambulance dispatch, initial actions and early pre-notification have a major impact on mortality and disability. The COVID-19 pandemic has led to disruptions in the operation of EMS due to the implementation of self-protection measures and increased demand for care. It is crucial to evaluate what has happened to draw the necessary conclusions and propose changes to improve the system's strength for the future. The study aims to compare prehospital time and neuroprotective care metrics for acute stroke patients during the first wave of COVID-19 and the same periods in the years before and after.
METHODS
Analytical, observational, multicentre study conducted in the autonomous communities of Andalusia, Catalonia, Galicia, and Madrid in the pre-COVID-19 (2019), "first wave" of COVID-19 (2020) and post-COVID-19 (2021) periods. Consecutive non-randomized sampling. Descriptive statistical analysis and hypothesis testing to compare the three time periods, with two by two post-hoc comparisons, and multivariate analysis.
RESULTS
A total of 1,709 patients were analysed. During 2020 there was a significant increase in attendance time of 1.8 min compared to 2019, which was not recovered in 2021. The time of symptom onset was recorded in 82.8% of cases, and 83.3% of patients were referred to specialized stroke centres. Neuroprotective measures (airway, blood glucose, temperature, and blood pressure) were performed in 43.6% of patients.
CONCLUSION
During the first wave of COVID-19, the on-scene times of pre-hospital emergency teams increased while keeping the same levels of neuroprotection measures as in the previous and subsequent years. It shows the resilience of EMS under challenging circumstances such as those experienced during the pandemic.
简介
中风是院前急救医疗服务（EMS）最常见的时间依赖性病理。优先派遣救护车、初步行动和提前通知对死亡率和残疾率有重大影响。由于采取自我保护措施以及对护理的需求增加，COVID-19 大流行导致 EMS 的运作受到干扰。评估所发生的情况以得出必要的结论并提出改进系统的建议，以提高未来系统的能力至关重要。本研究旨在比较 COVID-19 第一波期间和之前及之后年份的急性中风患者的院前时间和神经保护护理指标。
方法
在 COVID-19 之前（2019 年）、COVID-19“第一波”（2020 年）和 COVID-19 之后（2021 年）期间，在安达卢西亚、加泰罗尼亚、加利西亚和马德里自治区进行了分析性、观察性、多中心研究。连续非随机抽样。描述性统计分析和假设检验，以比较三个时间段，进行两两事后比较和多变量分析。
结果
共分析了 1709 名患者。与 2019 年相比，2020 年的到场时间增加了 1.8 分钟，这一情况在 2021 年并未得到恢复。记录了 82.8%的病例的症状发作时间，83.3%的患者被转介至专门的中风中心。对 43.6%的患者采取了神经保护措施（气道、血糖、体温和血压）。
结论
在 COVID-19 第一波期间，尽管与前几年和后几年相比，现场急救团队的时间增加了，但神经保护措施的水平保持不变。这表明在大流行期间等具有挑战性的情况下，EMS 具有弹性。
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