Introduction: Long low-flow times in patients with out-of-hospital cardiac arrest (OHCA) are associated with poor outcome. Signs of life during cardiopulmonary resuscitation (CPR) is a simple method to evaluate in the field, but little is known about its impact on survival in patients with long low-flow times. Hypothesis: Thirty-day survival in OHCA patients with long prehospital low-flow times is higher in patients with signs of life during CPR than in patients with no signs of life during CPR. Methods: Observational, retrospective, single center study of OHCA patients referred to a tertiary cardiac arrest center in the Central Demark Region from 2015-2018. Risk factors were assessed by univariate logistic regression. Comparisons were made by Kaplan-Meier survival curves and log-rank test. Results: In a cohort of 807 patients with OHCA, 30-day survival was seen in 364 (45%). Among patients discharged from hospital, favorable neurological outcome with CPC 1-2 was observed in 93%. Signs of life during CPR was present in 315 (39%) patients. Risk of 30-day mortality was significantly reduced in patients presenting signs of life during CPR (RR 0.25, 95% CI [0.20-0.30]). Poor survival was seen in patients with low-flow times exceeding 30 minutes compared to patients with shorter low-flow times, (11% versus 66%, p < 0.001). In patients with low-flow times > 30 min, the survival rate increased to 33 % in the presence of signs of life during CPR compared to only 3% in patients without signs of life during CPR, p < 0.001. Conclusions: In OHCA patients, low-flow times > 30 minutes were highly associated with poor survival, however signs of life during CPR predicts higher survival both in the overall population and in patients with long low-flow times. Thus, resuscitation efforts may not be futile in patients with long low-flow times presenting signs of life during CPR.
Introduction: Patients with out-of-hospital cardiac arrest (OHCA) are increasingly transported to tertiary cardiac arrest centers, when the arrest is presumed to be of cardiac origin. For some patients, centralization has led to longer transport distances to advanced care resulting in prolonged prehospital system delays, which may affect outcome. Hypothesis: Longer transport distance to center for patients with OHCA reduces 30-day survival. Methods: Central Denmark Region covers rural and urban areas of 13 000 square kilometers and has a population of approximately 1.3 million inhabitants. Aarhus University Hospital functions as the tertiary cardiac care hospital with access to 24/7 cardiac catherization service and extracorporeal cardiopulmonary resuscitation. Distance to center varies greatly among citizens in the region; with longest distance exceeding 170 km. This observational retrospective study included all patients with OHCA referred to Aarhus University Hospital from 2015 to 2018. Kaplan-Meier curves were conducted to evaluate association between distance and mortality. The odds of 30-day mortality were generated using logistic regression. Results: A total of 807 patients with OHCA were referred to center. Distance to center was < 25km (22%), 25 to 50km (40%), 50 to 100km (20%) and > 100km (18%), respectively. The median prehospital system delay from collapse to arrival at center was 70 minutes [IQR, 55-90 minutes]. Logistic regression did not demonstrate an association between 30-day mortality and increasing distance to center (distance < 25 km as reference, 25 to 50km: OR 0.83, 95% CI [0.58-1.20], 50 to 100km: OR 0.96, 95% CI [0.62-1.47] and >100km: OR 1.20, 95% CI [0.77-1.88]). Conclusions: In OHCA patients with long transport distances to a tertiary cardiac center, survival was similar in patients with short distance to center. Centralization of post cardiac care is feasible in the setting of long transport distances.
BackgroundTriage systems are used in emergency medical services to systematically prioritize prehospital resources according to individual patient conditions. Previous studies have shown cases of preventable deaths in emergency medical services even when triage systems are used, indicating a potential undertriage among some conditions. The aim of this study was to investigate the triage level among patients diagnosed with perforated peptic ulcer (PPU) or peptic ulcer bleeding (PUB).MethodsIn a three-year period in Central Denmark Region, all patients hospitalized within 24 h after a 1-1-2 emergency call and who subsequently received either a PPU or a PUB (hereinafter combined and referred to as PPU/PUB) or a First Hour Quintet (FHQ: respiratory failure, stroke, trauma, cardiac chest pain, and cardiac arrest) diagnosis were investigated. A modified Poisson regression was used to estimate the relative risk of receiving the highest and lowest prehospital response level. Also, a linear regression analysis was used to estimate the relative risk of 30-day mortality.ResultsOf 8658 evaluated patients, 263 were diagnosed with PPU/PUB. After adjusting for relevant confounding variables, patients diagnosed with PPU/PUB were less likely to receive ambulance transportation compared to patients diagnosed with stroke, RR = 1.41 (CI: 1.28–1.56); trauma, RR = 1.28 (CI: 1.15–1.42); cardiac chest pain, RR = 1.47 (CI: 1.33–1.62); and cardiac arrest, RR = 1.44 (CI: 1.31–1.42). Among patients diagnosed with PPU/PUB, 6.5% (CI: 3.3–9.7) did not receive ambulance transportation. The proportion of patients not receiving ambulance transportation was higher among patients diagnosed with PPU/PUB compared to patients diagnosed with an FHQ diagnosis. The 30-day mortality rate among patients diagnosed with PPU/PUB was 7.8% (CI: 4.2–11.1). This was lower than the 30-day mortality rate among patients diagnosed with respiratory failure (P = 0.010), stroke (P = 0.001), and cardiac arrest (P < 0.001), but comparable to the 30-day mortality among patients diagnosed with cardiac chest pain (P = 0.080) and trauma (P = 0.281).ConclusionAmong patients calling 1-1-2, fewer patients diagnosed with PPU/PUB received ambulance transportation than patients diagnosed with FHQ diagnoses, despite a high mortality among patients diagnosed with PPU/PUB.
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