Background Management of pre‐hospital patients remains a challenge. In developed countries a physician‐staffed helicopter emergency medical service (PS‐HEMS) is used in addition to ground emergency medical service (GEMS), but the effect is debated. This systematic review aimed to evaluate the effect of PS‐HEMS compared with GEMS on patient outcomes based on the published scientific literature. Methods Medline, EMBASE and the Cochrane Library were systematically searched on November 15, 2019 for prospective, interventional studies comparing outcomes of patients transported by either PS‐HEMS or GEMS. Outcomes of interest were mortality, time to hospital and quality of life. Results The majority of 18 studies included were observational and difficult to summarize because of heterogeneity. Meta‐analysis could not be carried out. Three studies found reduced mortality in patients transported by PS‐HEMS compared with GEMS with Odds ratios (OR) of 0.68 (0.47‐0.98); 0.29 (0.10‐0.82) and 0.21 (0.06‐0.73) respectively. Another two studies found improved survival with OR 1.2 (1.0‐1.5) and 6.9 (1.48‐32.5) in patients transported by PS‐HEMS compared with GEMS. In three studies, PS‐HEMS was associated with shorter time to hospital. Three studies reported quality of life and found no benefit of PS‐HEMS. Conclusion In this systematic review the studies comparing PS‐HEMS with GEMS were difficult to summarize because of heterogeneity. We found a possible survival benefit of PS‐HEMS but were unable to conduct a meta‐analysis. The overall quality of evidence was low.
BackgroundCardiac surgery is associated with a risk of complications, including post‐operative cognitive dysfunction (POCD). In the randomized Perfusion Pressure Cerebral Infarcts (PPCI) trial, we allocated cardiac surgery patients to either a low‐target mean arterial pressure (40‐50 mm Hg) or a high‐target pressure (70‐80 mm Hg). The study found no difference in the volume of new ischemic cerebral lesions nor POCD, but 30‐day mortality tended to be higher in the high‐target group. In the present study we did a long‐term 3‐year follow‐up to assess survival and level of cognitive functioning. The primary hypothesis was that patients allocated to a high‐target blood pressure had a higher long‐term mortality at 3‐year follow‐up.MethodsWe determined long‐term mortality of patients included in the PPCI trial at 3‐year follow‐up using national registries and we assessed POCD using a cognitive test battery. Subjective level of functioning was assessed with questionnaires. POCD and subjective functioning at follow‐up were evaluated in logistic regression models.ResultsAmong the 197 patients who participated in the original study, there was no significant difference in mortality over a median of 3.4 years according to blood pressure target during cardiopulmonary bypass (hazards ratio 1.23 [high vs low] 95% confidence interval: 0.50‐3.02, P = .65).POCD was found in 18.9% and 14.0% in the high‐target and low‐target groups, respectively adjusted odds ratio 1.01 (CI 95% 0.33‐3.12). No differences were found for subjective functioning between groups.ConclusionsNo difference in mortality nor in the level of cognitive functioning was found according to blood pressure target during cardiac surgery long‐term at 3‐year follow‐up.
far and how long to do. The blood analysis has not been described until now, as possible predictor of survival in these patients. Aim: To analyze pH, lactate, bases excess (BE) and pCO2 as possible predictive factors of survival in patients who suffer TCA. Method Observational Study of patients suffered from TCA in 2016, 2017 and 2018 assisted by our EMS. Collection data from medical records and databases of hospital follow-ups. Data processing and data analysis: quantitative variables are described by central and dispersion measures and qualitative variables by frequency distribution. COR as survival analysis. Excel and SPSS v. 20.0. Results We analyzed 112 TCA in which CPR is performed and recovered spontaneous circulation 49 (43.75%). After 7 days, 7.14% survived. At the arrival EMS, mean pH was 7.14 (SD 0.15), pCO2 66.57 (ED 20.61), BE À6.09 (ED 6.23) and Lactate 6.51 (ED 3.82). Lactate and PCO2 showed significant relationship in analysis of survival curve after 7 days (p<0,05). Conclusion The survival in TCA was 7.14% of patients after 7 days. -Lactate and PCO2 are related to survival at 7 days in our series. -It's necessary more robust studies that can define the factors related to the survival in TCA, but it seems that the biological clock can be one of them.
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