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Prehospital hemodynamic optimisation is associated with a 30-day mortality decrease in patients with septic shock.

Romain Jouffroy1, Basile Gilbert2, Papa-Ngalgou Gueye3

  • 1Intensive Care Unit, University Hospital Ambroise Paré - Boulogne Billancourt, France; Intensive Care Unit, Anaesthesiology, SAMU, Necker Enfants Malades Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.

The American Journal of Emergency Medicine
|March 8, 2021
PubMed
Summary
This summary is machine-generated.

Early hemodynamic optimization in septic shock patients cared for by mobile intensive care units significantly reduces 30-day mortality. Tailoring blood pressure targets based on hypertension history is crucial for prehospital resuscitation.

Keywords:
Hemodynamic optimisationMortalityPrehospital settingSeptic shock

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Area of Science:

  • Emergency Medicine
  • Critical Care Medicine
  • Cardiovascular Physiology

Background:

  • Septic shock (SS) is a life-threatening condition characterized by hypotension and organ dysfunction.
  • In-hospital studies suggest early hemodynamic resuscitation improves outcomes in SS.
  • The role of prehospital hemodynamic optimization in SS mortality remains under investigation.

Purpose of the Study:

  • To investigate the association between prehospital hemodynamic optimization and 30-day mortality in patients with septic shock.
  • To determine if individualized mean arterial pressure targets in the prehospital setting impact SS outcomes.

Main Methods:

  • Retrospective analysis of 337 patients with SS requiring prehospital Mobile Intensive Care Unit (mICU) intervention from April 2016 to December 2019.
  • Prehospital hemodynamic optimization defined as achieving a mean arterial pressure >65 mmHg (or >75 mmHg for hypertensive patients) by the end of prehospital care.
  • Cox regression analysis was used to assess the association with 30-day mortality.

Main Results:

  • Overall 30-day mortality was 30%.
  • Prehospital hemodynamic optimization was achieved in 61% of patients.
  • Cox regression analysis revealed a significant association between prehospital hemodynamic optimization and reduced 30-day mortality (HRa = 0.52; 95% CI [0.31-0.86]; p = 0.01).

Conclusions:

  • Prehospital hemodynamic optimization is linked to decreased 30-day mortality in septic shock patients managed by mICUs.
  • Individualized mean arterial pressure targets, considering hypertension history, should be evaluated for prehospital SS resuscitation.
  • Early, optimized hemodynamic management in the prehospital phase may improve septic shock survival rates.