Incidence of re-arrest and critical events during prolonged transport of post-cardiac arrest patients

RESUSCITATION

卷:81

Article; Proceedings Paper

Rittenberger, J. C.¹  Callaway, C. W.¹  Guyette, F. X.¹ 

[1] Univ Pittsburgh, Dept Emergency Med, Pittsburgh, PA 15261 USA

关键词: Cardiac arrest;    EMS;    Helicopter;    Hypothermia;    Resuscitation;   

DOI  :  10.1016/j.resuscitation.2010.04.012

来源: Elsevier

【 摘 要 】

Aim: To determine the feasibility of transporting post-cardiac arrest patients to tertiary-care facilities, the rate of re-arrest, and the rate of critical events during critical care transport team (CCTT) care. Methods: Retrospective chart review of cardiac arrest patients transported via CCIT between 1/1/2001 and 5/31/2009. Demographic information, re-arrest, and critical events during transport were abstracted. We defined critical events as hypotension (systolic blood pressure < 90mm Hg), hypoxia (oxygen saturation <90%), or both hypotension and hypoxia at any time during CCTT care. Comparisons were performed using Chi-squared test and a Cox proportional hazards model was employed to determine predictors of events. Results: Of the 248 patients studied, the majority was male (61%), presented in ventricular fibrillation or ventricular tachycardia (VF/VT, 50%), and comatose (80%). Re-arrest was uncommon (N = 15; 6%). Critical events affected 58 patients (23%) during transport. Median transport time was 63 min (IQR 51, 81) in both those who experienced a critical event and those who did not. Vasopressor use was associated with any decompensation during CM (Hazard Ratio 1.81; 95% CI 1.29, 2.54). Three patients (20%) suffering rearrest survived to hospital discharge. Survival (Chi square 11.77; p <0.01) and good neurologic outcome (Chi square 5.93; p = 0.01) were higher in patients who did not suffer any event during transport. Conclusions: Transport of resuscitated cardiac arrest patients to a tertiary-care facility via CCTT is feasible, and the duration of transport is not associated with re-arrest during transport. Repeat cardiac arrest occurs infrequently, while critical events are more common. Outcomes are worse in those experiencing an event. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free