Burla Michael J, Michalakes Peter C, Wishengrad Jeanne S, York Drew R, Stevens Holly A, May Teresa L
Department of Emergency Medicine Maine Medical Center Portland Maine USA.
Tufts University School of Medicine Boston Massachusetts USA.
J Am Coll Emerg Physicians Open. 2024 Oct 21;5(5):e13330. doi: 10.1002/emp2.13330. eCollection 2024 Oct.
There is significant variation in out-of-hospital cardiac arrest (OHCA) outcomes between different regions. We sought to evaluate outcomes of OHCA patients in the interfacility transfer (IFT) setting, between critical care transport (LifeFlight) and community Emergency Medical Services (EMS), in the state of Maine.
This was a retrospective analysis of our institution's electronic medical record and the Maine EMS database. Data were collected from January 1, 2019, to December 31, 2021. Only adult OHCA encounters requiring an IFT for definitive post-cardiac-arrest care were included. Demographics, EMS agency, IFT vital signs, targeted temperature management (TTM) medications, cerebral performance category (CPC) scores, survival to discharge, and other descriptive variables were collected.
Ninety-three patients met inclusion criteria, with LifeFlight transferring 30 of them (32.3%). LifeFlight was more likely to initiate TTM compared to other EMS agencies ( = 0.012), have run-sheets reported ( = 0.001), and serve rural areas ( = 0.036). LifeFlight was associated with more epinephrine (0.034) and norepinephrine (<0.001) use. Only 37% of IFTs had physician orders, with none (0.0%) of them defining vital sign targets. No difference in survival to discharge or CPC scores was observed between LifeFlight and other EMS agencies. No significant variation in comorbidities or vital signs was observed.
There was no difference in survival to discharge or CPC scores between LifeFlight and ad hoc EMS agency. LifeFlight was associated with more TTM and vasopressor utilization during IFT. Most IFT encounters did not have dedicated physician orders, and none of the orders included vital sign targets.
不同地区院外心脏骤停（OHCA）的结局存在显著差异。我们试图评估缅因州在机构间转运（IFT）环境下，重症监护转运（LifeFlight）和社区紧急医疗服务（EMS）之间OHCA患者的结局。
这是一项对我们机构的电子病历和缅因州EMS数据库的回顾性分析。数据收集时间为2019年1月1日至2021年12月31日。仅纳入需要进行IFT以接受心脏骤停后确定性治疗的成年OHCA病例。收集人口统计学数据、EMS机构、IFT生命体征、目标体温管理（TTM）用药、脑功能分类（CPC）评分、出院生存率及其他描述性变量。
93例患者符合纳入标准，其中30例（32.3%）由LifeFlight转运。与其他EMS机构相比，LifeFlight更有可能启动TTM（P = 0.012）、提交运行记录（P = 0.001）并服务于农村地区（P = 0.036）。LifeFlight使用肾上腺素（P = 0.034）和去甲肾上腺素（P < 0.001）的情况更多。只有37%的IFT有医生医嘱，其中无一（0.0%）明确生命体征目标。LifeFlight和其他EMS机构在出院生存率或CPC评分方面未观察到差异。在合并症或生命体征方面未观察到显著差异。
LifeFlight和临时EMS机构在出院生存率或CPC评分方面无差异。LifeFlight在IFT期间与更多的TTM和血管升压药使用相关。大多数IFT病例没有专门的医生医嘱，且无一医嘱包含生命体征目标。
