Introduction. The prognosis for the patients with the cardiovascular dysfunction and the use vasopressors or cardiotonics is always doubtful. Frequently patientʼs unstability and usage of vasoactive drugs increases the risks of incidents and are contraindication for medical evacuation. The results of published studies indicate that the use of these drugs when transporting patients is accompanied by certain risks, and methods for their prediction are not well described.
Objectives. Determine prognostic factors and evaluate the results of medical evacuation in patients requiring vasopressor and cardiotonic support.
Materials and methods. The retrospective study included 1210 patients from the database of the Tyumenʼs resuscitative-consultative center and the prospective study included 41 patients who were delivered to the Tyumen level III hospitals in 2019. Patients were distributed into 2 groups — survivors and deceased after evacuation.
Results. Our study showed the importance of the integral estimation of severity of patients subjected to medical evacuation and the high predictive value of the National Early Warning Score (NEWS) scale and Full Outline of UnResponsiveness (FOUR) at the stages of evacuation. In the next day after delivery, the Acute Physiology And Chronic Health Evaluation (APACHE II) scale demonstrated high prediction accuracy. Despite the risks associated with the development of undesirable situations during transportation (their frequency according to our data was 12.2 %), the evacuation of patients with cardiovascular dysfunction increases the chance of an favorable outcome 2.8 time.
Conclusions. Despite the presence of vascular dysfunction, the evacuation of patients in need of vasopressor and cardiotonic support is a life-saving measure that increases the chances of patients for a favorable outcome by 2.82 times.
- Tseng Y.-H., Kao C.-C., Lin C.-C., et al. Does Interhospital Transfer Influence the Outcomes of Patients Receiving Surgery for Acute Type A Aortic Dissection? Type A Aortic Dissection: Is Transfer Hazardous or Beneficial? Emergency Medicine International. Volume 2019, Article ID 5692083, 7 pages. DOI: 10.1155/2019/5692083.
- Venema E., Groot A.E., Lingsma H.F., et al. Effect of Interhospital Transfer on Endovascular Treatment for Acute Ischemic Stroke. Stroke. 2019; 50(4): 923–30. DOI: 10.1161/STROKEAHA.118.024091.
- Rush B., Tyler P.D., Stone D.J., et al. Outcomes of ventilated patients with sepsis who undergo inter-hospital transfer: a nationwide linked analysis. Crit Care Med. 2018; 46(1): e81–e86. DOI: 10.1097/CCM.0000000000002777.
- Stein L.K., Tuhrim S., Fifi J., et al. Interhospital Transfers for Endovascular Therapy for Acute Ischemic Stroke. Stroke. 2019; 50(7): 1789–96. DOI: 10.1161/STROKEAHA.119.024869.
- Herrigel D.J., Carroll M., Fanning C., et al. Interhospital transfer handoff practices among US tertiary care centers: A descriptive survey. J Hosp Med. 2016; 11(6): 413–7. DOI: 10.1002/jhm.2577.
- Loftus T.J., Wu Q., Wang Z., et al. Delayed inter-hospital transfer of critically ill patients with surgical sepsis. Journal of Trauma and Acute Care Surgery. 2019; 88(1): 1. DOI: 10.1097/ta.0000000000002476.
- Eiding H., Kongsgaard U.E., Braarud A. Interhospital transport of critically ill patients: experiences and challenges, a qualitative study. Scand J Trauma Resusc Emerg Med. 2019; 27. DOI: 10.1186/s13049-019-0604-8.
- Nathanson M.H., Andrzejowski J., Dinsmore J., et al. Guidelines for safe transfer of the brain‐injured patient: trauma and stroke. Guidelines from the Association of Anaesthetists and the Neuro Anaesthesia and Critical Care Society. Anaesthesia. 2019; 75(2): 234–46. First published: 01 December 2019. DOI: 10.1111/anae.14866.
- Гармаш О.А., Банин И.Н., Попов В.П. и др. Организация оказания экстренной консультативной медицинской помощи и проведения медицинской эвакуации: Методические рекомендации. М.: ФГБУ «ВЦМК “Защита”», 2015. (Библиотека ВСМК). [Garmash O.A., Banin I.N., Popov V.P., et al. Organizaciya okazaniya ekstrennoj konsulʼtativnoj medicinskoj pomoshchi i provedeniya medicinskoj evakuacii: Metodicheskie rekomendacii. (In Russ). M.: FGBU «VCMK “Zashchita”», 2015. (Biblioteka VSMK). (In Russ)]
- Касимов Р.Р., Махновский А.И., Миннуллин Р.И. и др. Медицинская эвакуация: организация и критерии транспортабельности пострадавших с тяжелой травмой. Политравма. 2018; 4: 14–21. [Kasimov R.R., Makhnovskiy A.I., Minnullin R.I., et al. Medical evacuation: organization and transportabiity criteria for patients with severe injury. Polytrauma. 2018; 4: 14–21. (In Russ)]
- Subbe C.P., Kruger M., Rutherford P., et al. Validation of a modified Early Warning Score in medical admissions. QJM — An International Journal of Medicine. 2001; 94(10): 521–6. DOI: 10.1093/qjmed/94.10.521.
- Royal College of Physicians London (2012) Royal College of Physicians London. London: Royal College of Physicians; 2012. National Early Warning Score (NEWS): Standardising the assessment of acute-illness severity in the NHS. Report of working party. [Google Scholar].
- Mitsunaga T., Hasegawa I., Uzura M., et al. Comparison of the National Early Warning Score (NEWS) and the Modified Early Warning Score (MEWS) for predicting admission and in-hospital mortality in elderly patients in the pre-hospital setting and in the emergency department. Peer J. 2019; 7: e6947. Published online 2019 May 16. DOI: 10.7717/peerj.6947.
- Gibbs S.G., Herstein J.J., Le A.B., et al. Review of Literature for Air Medical Evacuation High-Level Containment Transport. Air Med J. 2019; 38(5): 359–65. Published online 2019 Jul 18. DOI: 10.1016/j.amj.2019.06.006.
- Allyn J., Coolen-Allou N., de Parseval B., et al. Medical evacuation from abroad of critically ill patients. A case report and ethical issues/ Medicine (Baltimore). 2018; 97(38): e12516. Published online 2018 Sep 21. DOI: 10.1097/MD.0000000000012516.
- Vincent J-L. The continuum of critical care. Future of Critical Care Medicine (FCCM) 2018. Critical Care. 2019; 23, Abstract, Article number: 122.
- Maddry J.K., Perez C.A., Mora A.G., et al. Impact of prehospital medical evacuation (MEDEVAC) transport time on combat mortality in patients with non-compressible torso injury and traumatic amputations: a retrospective study. Mil Med Res. 2018; 5: 22. Published online 2018 Jun 30. DOI: 10.1186/s40779-018-0169-2.
- Tirkkonen J., Karlsson S., Skrifvars M.B. National early warning score (NEWS) and the new alternative SpO2 scale during rapid response team reviews: a prospective observational study. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2019; 27, Abstract, Article number: 111.
- Silcock D.J., Corfield A.R., Gowens P.A., et al. Validation of the National Early Warning Score in the prehospital setting. Resuscitation. 2015; 89: 31–5. DOI: 10.1016/j.resuscitation.2014.12.029.
- Alam N., Vegting I.L., Houben E., et al. Exploring the performance of the national early warning score (NEWS) in a European emergency department. Resuscitation. 2015; 90: 111– 5. DOI: 10.1016/j.resuscitation.2015.02.011.
- Hoikka M., Silfvast T., Ala-Kokko T.I. Does the prehospital National Early Warning Score predict the short-term mortality of unselected emergency patients? Scand J Trauma Resusc Emerg Med. 2018; 26: 48.
- Stead L.G., Wijdicks E.F.M., Bhagra A., et al. Validation of a new coma scale, the FOUR score, in the emergency department. Neurocrit Care, 2009; 10(1): 50–4. Epub 2008 Sep 20. DOI: 10.1002/ana.20611.
- Jiang Y., Yuan Y. Emergency Logistics in a Large-Scale Disaster Context: Achievements and Challenges. Int J Environ Res Public Health. 2019; 16(5): 779. Published online 2019 Mar 4. DOI: 10.3390/ijerph16050779.
- Wang H.E., Balasubramani G.K., Cook L.J., et al. Medical Conditions Associated with Out-of-Hospital Endotracheal Intubation. Prehosp Emerg Care. 2011; 15(3): 338–46. DOI: 10.3109/10903127.2011.569850.
- Zampieri F.G., Colombari F. The impact of performance status and comorbidities on the short-term prognosis of very elderly patients admitted to the ICU. BMC Anesthesiol. 2014; 14: 59. Published online 2014 Jul 22. DOI: 10.1186/1471-2253-14-59.
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