Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors
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Observational Study
Characteristics of nontrauma patients receiving prehospital blood transfusion with the same triggers as trauma patients: A retrospective observational cohort study.
Objective: While prehospital blood transfusion (PHBT) for trauma patients has been established in many services, the literature on PHBT use for nontrauma patients is limited. We aimed to describe and compare nontrauma and trauma patients receiving PHBT who had similar hemodynamic triggers. Methods: We analyzed 3.5 years of registry data from a single prehospital critical care unit. ⋯ On admission, the nontrauma patients had lower hemoglobin (median 95 [84-119] vs 124 [108-133], p < 0.0001), higher pH (median 7.40 [7.27-7.44] vs 7.30 [7.19-7.36], p = 0.0015) and lower plasma thromboplastin time (median 55 [45-81] vs 72 [58-86], p = 0.0261) than the trauma patients. Conclusions: We identified four nontrauma patient groups in need of PHBT, and the patients appeared to be seriously ill. Efficacy of prehospital transfusion in nontrauma patients should be evaluated futher in becoming studies.
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Background: Large and unacceptable variation exists in cardiac resuscitation care and outcomes across communities. Texas is the second most populous state in the US with wide variation in community and emergency response infrastructure. We utilized the Texas-CARES registry to perform the first Texas state analysis of out-of-hospital cardiac arrest (OHCA) in Texas, evaluating for variations in incidence, care, and outcomes. ⋯ Survival to hospital discharge ranged from 6.7% to 14.0%, and there were three communities above and two below the adjusted 95% confidence interval. Conclusion: While overall OHCA care and outcomes were similar in Texas compared to national averages, bystander CPR, bystander AED use, and survival varied widely across communities in Texas. These variations signal opportunities to improve OHCA care and outcomes in Texas.
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Objective: High quality cardiopulmonary resuscitation (CPR) is crucial for patients experiencing cardiac arrest. CPR quality declines within the first few minutes of CPR performance. Being more fit is associated with higher CPR quality, yet the fitness parameters needed remain uncertain. ⋯ Sex (female) was predictive of better chest compression recoil percentages (R2=0.15). Conclusion: Most rescuers can maintain high quality CPR if given two minute breaks between cycles. Rescuers with high anaerobic fitness and muscular strength may be able to provide higher quality CPR.
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Case Reports
Beyond Extracorporeal Cardiopulmonary Resuscitation: Systems of Care Supporting Cardiac Arrest Patients.
Introduction: Out-of-hospital cardiac arrest (OHCA) is a major cause of death and disability in the United States. Cardiac arrest centers (CAC) are necessary for the management of these critically ill and complex post arrest patients due to their specialized services and provider expertise. We report the case of a patient with OHCA and the systems of care involved in his resuscitation and recovery. ⋯ Conclusion: Cardiac arrest centers may be capable of advanced interventions including ECPR. However, the systems of care offered by these centers is itself a lifesaving intervention. As this case highlights, despite not receiving the specified intervention (ECPR) the systems of care required to offer such a resource led to this favorable outcome.
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Background: Prehospital emergency care is a vital component of healthcare access, and emergency medical services (EMS) plays an essential role in healthcare delivery. Understanding the distribution of medical and trauma EMS calls at the neighborhood level would be beneficial to identify at-risk communities and facilitate targeted interventions. Objectives: The primary objective was to evaluate and characterize 9-1-1 ambulance contacts for medical and trauma-related events in Denver. ⋯ When compared to the Denver County population, the tracts with high EMS call rates were diverse, with many tracts exhibiting a higher proportion of black, unemployment, below poverty, and lower median income while other tracts demonstrated a smaller proportion of black, unemployment, below poverty, and a higher median income. Conclusions: Disparities exist in the distribution of medical and trauma EMS calls in varied census tracts in Denver. Identifying neighborhoods in which there is an incidence of higher medical and trauma emergencies is important to guide EMS care delivery and may help facilitate targeted public health interventions for at-risk populations to improve health outcomes.