Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis.

IF 1.2 4区医学 Q3 EMERGENCY MEDICINE

Journal of Emergency Medicine Pub Date : 2024-06-19 DOI:10.1016/j.jemermed.2024.06.008

Thomas Vincent, Tiphaine Lefebvre, Mikaël Martinez, Guillaume Debaty, Cyril Noto-Campanella, Valentine Canon, Karim Tazarourte, Axel Benhamed

{"title":"Association Between Emergency Medical Services Intervention Volume and Out-of-Hospital Cardiac Arrest Survival: A Propensity Score Matching Analysis.","authors":"Thomas Vincent, Tiphaine Lefebvre, Mikaël Martinez, Guillaume Debaty, Cyril Noto-Campanella, Valentine Canon, Karim Tazarourte, Axel Benhamed","doi":"10.1016/j.jemermed.2024.06.008","DOIUrl":null,"url":null,"abstract":"Background: Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown.Objectives: To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA.Methods: A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used.Results: 2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).","PeriodicalId":16085,"journal":{"name":"Journal of Emergency Medicine","volume":" ","pages":""},"PeriodicalIF":1.2000,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Emergency Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jemermed.2024.06.008","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}

引用次数: 0

Abstract

Background: Out of hospital cardiac arrest (OHCA) survival rates are very low. An association between institutional OHCA case volume and patient outcomes has been documented. However, whether this applies to prehospital emergency medicine services (EMS) is unknown.

Objectives: To investigate the association between the volume of interventions by mobile intensive care units (MICU) and outcomes of patients experiencing an OHCA.

Methods: A retrospective cohort study including adult patients with OHCA managed by medical EMS in five French centers between 2013 and 2020. Two groups were defined depending on the overall annual numbers of MICU interventions: low and high-volume MICU. Primary endpoint was 30-day survival. Secondary endpoints were prehospital return of spontaneous circulation (ROSC), ROSC at hospital admission and favorable neurological outcome. Patients were matched 1:1 using a propensity score. Conditional logistic regression was then used.

Results: 2,014 adult patients (69% male, median age 68 [57-79] years) were analyzed, 50.5% (n = 1,017) were managed by low-volume MICU and 49.5% (n = 997) by high-volume MICU. Survival on day 30 was 3.6% in the low-volume group compared to 5.1% in the high-volume group. There was no significant association between MICU volume of intervention and survival on day 30 (OR = 0.92, 95%CI [0.55;1.53]), prehospital ROSC (OR = 1.01[0.78;1.3]), ROSC at hospital admission (OR = 0.92 [0.69;1.21]), or favorable neurologic prognosis on day 30 (OR = 0.92 [0.53;1.62]).

查看原文本刊更多论文

紧急医疗服务干预量与院外心脏骤停存活率之间的关系：倾向得分匹配分析。

背景：院外心脏骤停（OHCA）的存活率非常低。有资料表明，院外心脏骤停病例量与患者预后之间存在关联。然而，院前急救医疗服务（EMS）是否也存在这种情况还不得而知：调查移动重症监护室（MICU）的干预量与 OHCA 患者预后之间的关系：方法：一项回顾性队列研究，包括2013年至2020年期间在法国5个中心由医疗急救服务管理的OHCA成人患者。根据 MICU 每年的总干预次数定义了两组：低流量和高流量 MICU。主要终点是 30 天存活率。次要终点是院前自主循环恢复（ROSC）、入院时自主循环恢复和良好的神经功能预后。采用倾向评分法对患者进行 1:1 匹配。结果：共分析了 2,014 名成年患者（69% 为男性，中位年龄为 68 [57-79] 岁），其中 50.5% （n = 1,017 人）由低容量 MICU 管理，49.5% （n = 997 人）由高容量 MICU 管理。低容量组第 30 天的存活率为 3.6%，而高容量组为 5.1%。MICU 干预量与第 30 天存活率（OR = 0.92，95%CI [0.55;1.53]）、院前 ROSC（OR = 1.01[0.78;1.3]）、入院时 ROSC（OR = 0.92 [0.69;1.21]）或第 30 天良好的神经预后（OR = 0.92 [0.53;1.62]）之间无明显关联。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Emergency Medicine 医学-急救医学

CiteScore

2.40

自引率

6.70%

发文量

339

审稿时长

2-4 weeks

期刊介绍： The Journal of Emergency Medicine is an international, peer-reviewed publication featuring original contributions of interest to both the academic and practicing emergency physician. JEM, published monthly, contains research papers and clinical studies as well as articles focusing on the training of emergency physicians and on the practice of emergency medicine. The Journal features the following sections: • Original Contributions • Clinical Communications: Pediatric, Adult, OB/GYN • Selected Topics: Toxicology, Prehospital Care, The Difficult Airway, Aeromedical Emergencies, Disaster Medicine, Cardiology Commentary, Emergency Radiology, Critical Care, Sports Medicine, Wound Care • Techniques and Procedures • Technical Tips • Clinical Laboratory in Emergency Medicine • Pharmacology in Emergency Medicine • Case Presentations of the Harvard Emergency Medicine Residency • Visual Diagnosis in Emergency Medicine • Medical Classics • Emergency Forum • Editorial(s) • Letters to the Editor • Education • Administration of Emergency Medicine • International Emergency Medicine • Computers in Emergency Medicine • Violence: Recognition, Management, and Prevention • Ethics • Humanities and Medicine • American Academy of Emergency Medicine • AAEM Medical Student Forum • Book and Other Media Reviews • Calendar of Events • Abstracts • Trauma Reports • Ultrasound in Emergency Medicine