Prehospital Care Duration and 30-Day Mortality Among Septic Shock

Septic shock may occur in the prehospital setting requiring a prehospital mobile intensive care unit (MICU) intervention. The prehospital MICU is equipped to deliver antibiotics and hemodynamic optimization on scene in order to implement effective treatment measures within the initial hour. The study objective is to assess the relationship between the duration of prehospital care and 30-day mortality among patients with septic shock who received MICU prehospital antibiotic and norepinephrine administration.

From 2016, May, to 2021, March, patients with septic shock managed by a prehospital MICU of nine French hospital centers were retrospectively analyzed. Multivariate logistic regression and propensity score analysis with the inverse probability weighting (IPTW) method were used to assess the association between prehospital care duration and 30-day mortality.

Five-hundred and thirty patients were analyzed among which 341 (64%) were males, and the mean age was 70 ± 15 years old. The 3 main presumed sepsis origins were pulmonary, digestive, and urinary for 43%, 25%, and 17% of the patients, respectively. One-hundred and thirty-two patients (25%) received prehospital antibiotic and 155 (29%) norepinephrine administration with a median dose of 1.0 [0.5-2.0] mg.h^-1 within the first prehospital hour. The 30-day mortality was 31%. The mean prehospital care duration was 71 ± 34 min. Multivariate logistic regression analysis revealed an association between prehospital care duration and 30-day mortality rate: adjusted odds ratio (aOR) = 1.01 [1.00-1.02], p = 0.017. Multivariate logistic regression adjusted on the same potential confounders reported an association between prehospital care duration < 60 min and 30-day mortality: aOR = 0.64 [0.41-0.99], p = 0.044. Log binomial regression weighted with the IPTW revealed an association between prehospital care duration < 60 min and 30-day mortality: aOR = 0.56 [0.46-0.67], p < 10^-3.

The present study reports the association between prehospital care duration and 30-day mortality among septic shock patients who received MICU prehospital antibiotic and norepinephrine administration.