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The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.

ABSTRACT: Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit.Prospective, observational study with 5.5 years of follow-up. We included patients admitted to the stroke unit the first three years after implementation of a helicopter emergency medical services (HEMS) from a geographical area covered by both the HEMS and the ground emergency medical services (GEMS). HEMS patients were compared with GEMS patients. Primary outcome was long-term mortality after admission to the stroke unit.Of the 1679 patients admitted to the stroke unit, 1068 were eligible for inclusion. Mortality rates were 9.04 per 100 person-years at risk (PYR) in GEMS patients and 9.71 per 100 PYR in HEMS patients (IRR?=?1.09, 95% CI 0.79-1.49; p?=?0.60). The 30-day mortality was 7.4% with GEMS and 7.9% with HEMS (OR?=?1.02, CI 0.53-1.96; p?=?0.96). Incidence rate of involuntary early retirement was 6.97 per 100 PYR and 7.58 per 100 PYR in GEMS and HEMS patients, respectively (IRR?=?1.19, CI 0.27-5.26; p?=?0.81). Work ability after 2 years and time on social transfer payments did not differ between groups. We found no significant difference in mean modified Rankin Scale score after 3 months (2.21 GEMS vs. 2.09 HEMS; adjusted mean difference?=?-0.20, CI -0.74-0.33; p?=?0.46).The possible benefit of HEMS for neurological outcome is probably difficult to detect by considering mortality, but for the secondary analyses we had less statistical power as illustrated by the wide confidence intervals.Helicopter transport of stroke patients was not associated with reduced mortality or disability, nor improved labour market affiliation compared to patients transported by a ground unit.The study was registered at ClinicalTrials.gov ( NCT02576379 ).

SUBMITTER: Funder KS

PROVIDER: S-EPMC5322627 | biostudies-literature | 2017 Feb

REPOSITORIES: biostudies-literature

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The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.

Funder Kamilia S KS Rasmussen Lars S LS Lohse Nicolai N Hesselfeldt Rasmus R Siersma Volkert V Gyllenborg Jesper J Wulffeld Sandra S Hendriksen Ole M OM Lippert Freddy K FK Steinmetz Jacob J

Scandinavian journal of trauma, resuscitation and emergency medicine 20170223 1

<h4>Background</h4>Transportation by helicopter may reduce time to hospital admission and improve outcome. We aimed to investigate the effect of transport mode on mortality, disability, and labour market affiliation in patients admitted to the stroke unit.<h4>Methods</h4>Prospective, observational study with 5.5 years of follow-up. We included patients admitted to the stroke unit the first three years after implementation of a helicopter emergency medical services (HEMS) from a geographical area ...[more]

PMID: 28231814

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Project description:Despite numerous studies on prehospital airway management, results are difficult to compare due to inconsistent or heterogeneous data. The objective of this study was to assess advanced airway management from international physician-staffed helicopter emergency medical services.We collected airway data from 21 helicopter emergency medical services in Australia, England, Finland, Hungary, Norway and Switzerland over a 12-month period. A uniform Utstein-style airway template was used for collecting data.The participating services attended 14,703 patients on primary missions during the study period, and 2,327 (16 %) required advanced prehospital airway interventions. Of these, tracheal intubation was attempted in 92 % of the cases. The rest were managed with supraglottic airway devices (5 %), bag-valve-mask ventilation (2 %) or continuous positive airway pressure (0.2 %). Intubation failure rates were 14.5 % (first-attempt) and 1.2 % (overall). Cardiac arrest patients showed significantly higher first-attempt intubation failure rates (odds ratio: 2.0; 95 % CI: 1.5-2.6; p?<?0.001) compared to non-cardiac arrest patients. Complications were recorded in 13 %, with recognised oesophageal intubation being the most frequent (25 % of all patients with complications). For non-cardiac arrest patients, important risk predictors for first-attempt failure were patient age (a non-linear association) and administration of sedatives (reduced failure risk). The patient's sex, provider's intubation experience, trauma type (patient category), indication for airway intervention and use of neuromuscular blocking agents were not risk factors for first-attempt intubation failure.Advanced airway management in physician-staffed prehospital services was performed frequently, with high intubation success rates and low complication rates overall. However, cardiac arrest patients showed significantly higher first-attempt failure rates compared to non-cardiac arrest patients. All failed intubations were handled successfully with a rescue device or surgical airway.www.clinicaltrials.gov NCT01502111 . Registered 22 December 2011.

Project description:BackgroundThe effective treatment of airway compromise in trauma and non-trauma patients is important. Hypoxia and hypotension are predictors of negative patient outcomes and increased mortality, and may be important quality indicators of care provided by emergency medical services. Excluding cardiac arrests, critical trauma and non-trauma patients remain the two major groups to which helicopter emergency medical services (HEMS) are dispatched. Several studies describe the impact of pre-hospital hypoxia or hypotension on trauma patients, but few studies compare this in trauma and non-trauma patients. The primary aim was to describe the incidence of pre-hospital hypoxia and hypotension in the two groups receiving pre-hospital tracheal intubation (TI) by physician-staffed HEMS.MethodsData were collected prospectively over a 12-month period, using a uniform Utstein-style airway template. Twenty-one physician-staffed HEMS in Europe and Australia participated. We compared peripheral oxygen saturation and systolic blood pressure before and after definitive airway management. Data were analysed using Cochran-Mantel-Haenszel methods and mixed-effects models.ResultsEight hundred forty three trauma patients and 422 non-trauma patients receiving pre-hospital TI were included. Non-trauma patients had significantly lower predicted mean pre-intervention SpO2 compared to trauma patients. Post-intervention and admission SpO2 for the two groups were comparable. However, 3% in both groups were still hypoxic at admission. For hypotension, the differences between the groups were less prominent. However, 9% of trauma and 10% of non-trauma patients were still hypotensive at admission. There was no difference in short-term survival between trauma (97%) and non-trauma patients (95%). Decreased level of consciousness was the most frequent indication for TI, and was associated with increased survival to hospital (cOR 2.8; 95% CI: 1.4-5.4).ConclusionsOur results showed that non-trauma patients had a higher incidence of hypoxia before TI than trauma patients, but few were hypoxic at admission. The difference for hypotension was less prominent, but one in ten patients were still hypotensive at admission. Further investigations are needed to identify reversible causes that may be corrected to improve haemodynamics in the pre-hospital setting. We found high survival rates to hospital in both groups, suggesting that physician-staffed HEMS provide high-quality emergency airway management in trauma and non-trauma patients.Trial registrationClinicaltrials.gov Identifier: NCT01502111 . Registered 22 Desember 2011.

Project description:BackgroundAs pediatric patients are typically rare among helicopter emergency medical systems (HEMS), children might be at risk for oligo-analgesia due to the rescuer's lack of experience and the fear of side effects.MethodsIn this retrospective analysis, data was obtained from the ÖAMTC HEMS digital database including 14 physician staffed helicopter bases in Austria over a 12-year timeframe. Primary missions involving pediatric trauma patients (< 15 years) not mechanically ventilated on-site were included. Analgesia was assessed and compared between the age groups 0-5, 6-10 and 11-14 years.ResultsOf all flight missions, 8.2% were dedicated to children < 15 years. Analgetic drugs were administered in 31.4% of all primary missions (3874 of 12,324), wherefrom 2885 were injured and non-ventilated (0-5 yrs.: n = 443; 6-10 yrs.: n = 902; 11-14 yrs.: n = 1540). The majority of these patients (> 75%) suffered moderate to severe pain, justifying immediate analgesia. HEMS physicians typically chose a monotherapy with an opioid (n = 1277; 44.3%) or Esketamine (n = 1187; 41.1%) followed by the combination of both (n = 324; 11.2%). Opioid use increased (37.2% to 63.4%) and Esketamine use decreased (66.1% to 48.3%) in children < 6 vs. > 10 years. Esketamine was more often administered in extremity (57.3%) than in head (41.5%) or spine injuries (32.3%). An intravenous access was less often established in children < 6 years (74.3% vs. 90.8%; p < 0.001). Despite the use of potent analgesics, 396 missions (13.7%) were performed without technical monitoring. Particularly regarding patient data at handover in hospital, merely < 10% of all missions featured complete documentation. Therefore, sufficient evaluation of the efficacy of pain relief was not possible. Yet, by means of respiratory measures required during transport, severe side effects such as respiratory insufficiency, were barely noted.ConclusionsIn the physician-staffed HEMS setting, pediatric trauma patients liberally receive opioids and Esketamine for analgesia. With regard to severe respiratory insufficiency during transport, the application of these potent analgesics seems safe.

Project description:ObjectivesThe number of stroke patients receiving recombinant tissue plasminogen activator (r-tPA) in developing world is extremely low. Pre-hospital delay, financial constraints and lack of infrastructure are the main barriers. Additionally, various medical, neurological and psychological complications are allied to stroke patients after the acute attack. Hence, the study was aimed to identify management protocols and encountered complications among stroke patients admitted to stroke unit of Jimma university medical center (JUMC).Patients and methodsProspective observational study was conducted at stroke unit of JUMC from March 10 to July 10, 2017. All eligible consecutive stroke patients of ≥18 years were included. Data was entered to Epi data version 3.1 and analyzed using SPSS version 20.ResultsA total of 116 eligible stroke patients were followed with mean age of 55.14 ± 14.04 years and males comprised of 62.9%. Using world health organization (WHO) criteria, 60 (51.7%) patients had ischemic while 56 (48.3%) had hemorrhagic stroke. During admission, 93 (80.2%) patients had developed at least one complication. The most complication was brain edema (increased intracranial pressure) detected in about one third of the patients (30.2%) followed by urinary incontinence (28.4%) and aspiration pneumonia (19.8%). Almost half of the patients (52.5%) had at least one past medication history. During hospitalization, 111(95.7%) of patients had received at least one medication and the median start time of the medications after hospital arrival was 15 h. The most common medication given for the patients during hospitalization were antiplatelets and statins for 63 (54.3%) patients. During discharge, about 78 (67.2%) patients had received medications and antihypertensives were the prominent medications prescribed for half of the discharged patients.ConclusionBoth neurologic and medical complications were common in majority of stroke patients. But the management protocol for stroke patients was sub-optimal and lagging behind the recommended guidelines due to lack of skilled personnel, appropriate treatment and diagnostic agents. The clinical team involved in the care of stroke patients should make preparations to take preventive measures that will save a lot of lives.

Project description:BACKGROUND:Stroke is the second-leading global cause of death behind heart disease in 2013 and is a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. It is currently observed to be one of the commonest reasons of admission in many health care setups and becoming an alarming serious public health problem in our country Ethiopia. Despite the high burden of strokes globally, there is insufficient information on the current clinical profile of stroke in low and middle income countries (LMICs) including Ethiopia. So, this study was aimed to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients admitted to stroke unit of Jimma university medical center (JUMC). METHODS:Prospective observational study design was carried out at stroke unit (SU) of JUMC for 4 consecutive months from March 10-July 10, 2017. A standardized data extraction checklist and patient interview was used to collect data. Data was entered into Epi data version 3.1 and analyzed using SPSS version 20. Multivariable logistic regression was used to identify the predictors of stroke subtypes. RESULT:A total of 116 eligible stroke patients were recruited during the study period. The mean age of the patients was 55.1?±?14.0?years and males comprised 62.9%. According to world health organization (WHO) criteria of stroke diagnosis, 51.7% of patients had ischemic while 48.3% had hemorrhagic stroke. The most common risk factor identified was hypertension (75.9%) followed by family history (33.6%), alcohol intake (22.4%), smoking (17.2%) and heart failure (17.2%). The most common clinical presentation was headache complained by 75.0% of the patients followed by aphasia 60.3% and hemiparesis 53.4%. Atrial fibrillation was the independent predictor of hemorrhagic stroke (AOR: 0.08, 95% CI: 0.01-0.68). CONCLUSION:The clinical characteristics of stroke in this set up were similar to other low- and middle-resource countries. As stroke is a high priority chronic disease, large-scale public health campaign should be launched focusing on public education regarding stroke risk factors and necessary interventions.

Project description:BackgroundStroke is the second-leading global cause of death behind heart disease in 2013 and is a major cause of permanent disability. The burden of stroke in terms of mortality, morbidity and disability is increasing across the world. It is currently observed to be one of the commonest reasons of admission in many health care setups and becoming an alarming serious public health problem in our country Ethiopia. Despite the high burden of strokes globally, there is insufficient information on the current clinical profile of stroke in low and middle income countries (LMICs) including Ethiopia. So, this study was aimed to assess risk factors, clinical presentations and predictors of stroke subtypes among adult patients admitted to stroke unit of Jimma university medical center (JUMC).MethodsProspective observational study design was carried out at stroke unit (SU) of JUMC for 4 consecutive months from March 10-July 10, 2017. A standardized data extraction checklist and patient interview was used to collect data. Data was entered into Epi data version 3.1 and analyzed using SPSS version 20. Multivariable logistic regression was used to identify the predictors of stroke subtypes.ResultA total of 116 eligible stroke patients were recruited during the study period. The mean age of the patients was 55.1 ± 14.0 years and males comprised 62.9%. According to world health organization (WHO) criteria of stroke diagnosis, 51.7% of patients had ischemic while 48.3% had hemorrhagic stroke. The most common risk factor identified was hypertension (75.9%) followed by family history (33.6%), alcohol intake (22.4%), smoking (17.2%) and heart failure (17.2%). The most common clinical presentation was headache complained by 75.0% of the patients followed by aphasia 60.3% and hemiparesis 53.4%. Atrial fibrillation was the independent predictor of hemorrhagic stroke (AOR: 0.08, 95% CI: 0.01-0.68).ConclusionThe clinical characteristics of stroke in this set up were similar to other low- and middle-resource countries. As stroke is a high priority chronic disease, large-scale public health campaign should be launched focusing on public education regarding stroke risk factors and necessary interventions.

Dataset Information

The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.

Publications

The impact of a physician-staffed helicopter on outcome in patients admitted to a stroke unit: a prospective observational study.

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