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Respiratory and circulatory insufficiency during emergent long-distance critical care interhospital transports to tertiary care in a sparsely populated region: a retrospective analysis of late mortality risk
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. (Michael Haney)ORCID iD: 0000-0002-3586-4197
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.ORCID iD: 0000-0002-2924-8021
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2022 (English)In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 2, article id e051217Article in journal (Refereed) Published
Abstract [en]

Objectives: To test if impaired oxygenation or major haemodynamic instability at the time of emergency intensive care transport, from a smaller admitting hospital to a tertiary care centre, are predictors of long-term mortality.

Design: Retrospective observational study. Impaired oxygenation was defined as oxyhaemoglobin %–inspired oxygen fraction ratio (S/F ratio)<100. Major haemodynamic instability was defined as a need for treatment with norepinephrine infusion to sustain mean arterial pressure (MAP) at or above 60 mm Hg or having a mean MAP <60. Logistic regression was used to assess mortality risk with impaired oxygenation or major haemodynamic instability.

Setting: Sparsely populated Northern Sweden. A fixed-wing interhospital air ambulance system for critical care serving 900 000 inhabitants.

Participants: Intensive care cases transported in fixed-wing air ambulance from outlying hospitals to a regional tertiary care centre during 2000–2016 for adults (16 years old or older). 2142 cases were included.

Primary and secondary outcome measures: All-cause mortality at 3 months after transport was the primary outcome, and secondary outcomes were all-cause mortality at 1 and 7 days, 1, 6 and 12 months.

Results: S/F ratio <100 was associated with increased mortality risk compared with S/F>300 at all time-points, with adjusted OR 6.3 (2.5 to 15.5, p<0.001) at 3 months. Major haemodynamic instability during intensive care unit (ICU) transport was associated with increased adjusted OR of all-cause mortality at 3 months with OR 2.5 (1.8 to 3.5, p<0.001).

Conclusion: Major impairment of oxygenation and/or major haemodynamic instability at the time of ICU transport to get to urgent tertiary intervention is strongly associated with increased mortality risk at 3 months in this cohort. These findings support the conclusion that these conditions are markers for many fold increase in risk for death notable already at 3 months after transport for patients with these conditions.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2022. Vol. 12, no 2, article id e051217
National Category
Anesthesiology and Intensive Care
Identifiers
URN: urn:nbn:se:umu:diva-192545DOI: 10.1136/bmjopen-2021-051217ISI: 000780118100029PubMedID: 35168967Scopus ID: 2-s2.0-85124679769OAI: oai:DiVA.org:umu-192545DiVA, id: diva2:1638296
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Region VästerbottenAvailable from: 2022-02-16 Created: 2022-02-16 Last updated: 2023-09-05Bibliographically approved

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Fredriksson Sundbom, MarcusNyström, HelenaJohansson, GöranBrändstrom, HelgeHaney, Michael

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