Effect of early initiation of noninvasive ventilation in patients transported by emergency medical service for acute heart failure.

IF 3.1 4区 医学 Q1 EMERGENCY MEDICINE
European Journal of Emergency Medicine Pub Date : 2024-10-01 Epub Date: 2024-06-07 DOI:10.1097/MEJ.0000000000001141
Judith Gorlicki, Josep Masip, Víctor Gil, Pere Llorens, Javier Jacob, Aitor Alquézar-Arbé, Eva Domingo Baldrich, María José Fortuny, Marta Romero, Marco Antonio Esquivias, Rocío Moyano García, Yelenis Gómez García, José Noceda, Pablo Rodríguez, Alfons Aguirre, M Pilar López-Díez, María Mir, Leticia Serrano, Marta Fuentes de Frutos, David Curtelín, Yonathan Freund, Òscar Miró
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引用次数: 0

Abstract

Background: While the indication for noninvasive ventilation (NIV) in severely hypoxemic patients with acute heart failure (AHF) is often indicated and may improve clinical course, the benefit of early initiation before patient arrival to the emergency department (ED) remains unknown.

Objective: This study aimed to assess the impact of early initiation of NIV during emergency medical service (EMS) transportation on outcomes in patients with AHF.

Design: A secondary retrospective analysis of the EAHFE (Epidemiology of AHF in EDs) registry.

Setting: Fifty-three Spanish EDs.

Participants: Patients with AHF transported by EMS physician-staffed ambulances who were treated with NIV at any time during of their emergency care were included and categorized into two groups based on the place of NIV initiation: prehospital (EMS group) or ED (ED group).

Outcome measures: Primary outcome was the composite of in-hospital mortality and 30-day postdischarge death, readmission to hospital or return visit to the ED due to AHF. Secondary outcomes included 30-day all-cause mortality after the index event (ED admission) and the different component of the composite primary endpoint considered individually. Multivariate logistic regressions were employed for analysis.

Results: Out of 2406 patients transported by EMS, 487 received NIV (EMS group: 31%; EMS group: 69%). Mean age was 79 years, 48% were women. The EMS group, characterized by younger age, more coronary artery disease, and less atrial fibrillation, received more prehospital treatments. The adjusted odds ratio (aOR) for composite endpoint was 0.66 (95% CI: 0.42-1.05). The aOR for secondary endpoints were 0.74 (95% CI: 0.38-1.45) for in-hospital mortality, 0.74 (95% CI: 0.40-1.37) for 30-day mortality, 0.70 (95% CI: 0.41-1.21) for 30-day postdischarge ED reconsultation, 0.80 (95% CI: 0.44-1.44) for 30-day postdischarge rehospitalization, and 0.72 (95% CI: 0.25-2.04) for 30-day postdischarge death.

Conclusion: In this ancillary analysis, prehospital initiation of NIV in patients with AHF was not associated with a significant reduction in short-term outcomes. The large confidence intervals, however, may preclude significant conclusion, and all point estimates consistently pointed toward a potential benefit from early NIV initiation.

对因急性心力衰竭而被紧急医疗服务转运的患者及早启动无创通气的影响。
背景:虽然急性心力衰竭(AHF)严重低氧血症患者通常有无创通气(NIV)指征,并可改善临床病程,但在患者到达急诊科(ED)之前尽早启动无创通气的益处仍不清楚:本研究旨在评估在急救医疗服务(EMS)转运过程中尽早开始 NIV 对急性心力衰竭患者预后的影响:设计:对 EAHFE(急诊室 AHF 流行病学)登记进行二次回顾性分析:53 家西班牙急诊室:根据开始 NIV 的地点分为两组:院前(EMS 组)或 ED(ED 组):主要结果是院内死亡率和出院后30天死亡、再次入院或因AHF再次就诊急诊室的综合结果。次要结果包括指数事件(急诊室入院)后30天的全因死亡率,以及单独考虑的复合主要终点的不同组成部分。采用多变量逻辑回归进行分析:在由急救中心转运的2406名患者中,487人接受了NIV治疗(急救中心组:31%;急救中心组:69%)。平均年龄为 79 岁,48% 为女性。急救医疗组的特点是年龄较小、冠状动脉疾病较多、心房颤动较少,接受的院前治疗较多。综合终点的调整赔率(aOR)为0.66(95% CI:0.42-1.05)。次要终点的 aOR 分别为:院内死亡率为 0.74(95% CI:0.38-1.45),30 天死亡率为 0.74(95% CI:0.40-1.37),出院后 30 天急诊室复诊率为 0.70(95% CI:0.41-1.21),出院后 30 天再次住院率为 0.80(95% CI:0.44-1.44),出院后 30 天死亡率为 0.72(95% CI:0.25-2.04):结论:在这项辅助分析中,院前启动 NIV 并未显著降低 AHF 患者的短期预后。然而,较大的置信区间可能无法得出明显的结论,所有的点估计结果都一致表明,早期启动 NIV 有可能带来益处。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.60
自引率
27.30%
发文量
180
审稿时长
6-12 weeks
期刊介绍: The European Journal of Emergency Medicine is the official journal of the European Society for Emergency Medicine. It is devoted to serving the European emergency medicine community and to promoting European standards of training, diagnosis and care in this rapidly growing field. Published bimonthly, the Journal offers original papers on all aspects of acute injury and sudden illness, including: emergency medicine, anaesthesiology, cardiology, disaster medicine, intensive care, internal medicine, orthopaedics, paediatrics, toxicology and trauma care. It addresses issues on the organization of emergency services in hospitals and in the community and examines postgraduate training from European and global perspectives. The Journal also publishes papers focusing on the different models of emergency healthcare delivery in Europe and beyond. With a multidisciplinary approach, the European Journal of Emergency Medicine publishes scientific research, topical reviews, news of meetings and events of interest to the emergency medicine community. Submitted articles undergo a preliminary review by the editor. Some articles may be returned to authors without further consideration. Those being considered for publication will undergo further assessment and peer-review by the editors and those invited to do so from a reviewer pool. ​
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