Prehospital Bundle of Care Based on Antibiotic Therapy and Hemodynamic Optimization Is Associated With a 30-Day...

Area of Science:

• Emergency Medicine
• Critical Care Medicine
• Infectious Diseases

Background:

• International guidelines emphasize early treatment for septic shock (SS) to reduce mortality.
• A comprehensive bundle of care, integrating antibiotic therapy and hemodynamic optimization, is more effective than single interventions.
• Prehospital management is crucial for patients with SS requiring mobile intensive care unit (mICU) intervention.

Purpose of the Study:

• To investigate the association between prehospital bundle of care (BUC) completion and 30-day mortality in patients with SS.
• To assess the impact of antibiotic therapy and hemodynamic optimization on SS patient outcomes.
• To evaluate the effectiveness of mICU interventions in reducing SS mortality.

Main Methods:

• Retrospective analysis of 529 patients with SS requiring mICU intervention from May 2016 to March 2021.
• Application of the inverse probability treatment weighting (IPTW) propensity method to assess the association between BUC completion and 30-day mortality.
• Log binomial regression analysis to determine the impact of prehospital interventions on mortality.

Main Results:

• The study analyzed 354 patients with SS; overall 30-day mortality was 32%.
• Twenty percent of patients received prehospital antibiotic therapy and fluid expansion.
• Prehospital BUC completion was significantly associated with a reduction in 30-day mortality (adjusted RR 0.52; p = 0.03).

Conclusions:

• A prehospital bundle of care, encompassing antibiotic therapy and hemodynamic optimization, is linked to decreased 30-day mortality in SS patients treated by mICUs.
• Early and comprehensive prehospital interventions are vital for improving survival in septic shock.
• The findings support the implementation of standardized prehospital care bundles for SS patients.