Prehospital transportation, management, and outcome of cardiogenic shock in Northern Norway

Abstract

<p>Introduction: This study aimed to determine the impact of prehospital management and transfer to a tertiary hospital on the outcome of cardiogenic shock in a rural/urban setting. <p>Methods: Patients treated for cardiogenic shock in the period of 01.01.2019 to 31.12.2021, were retrospectively analysed with regards to transportation route, time to definite treatment, prehospital and intrahospital treatment, and outcome (mortality). Patients were anonymously recorded in a structured case report and analysed using SPSS. <p>Results: 83 consecutive patients were included in two cohorts; 34 patients were admitted directly to the tertiary care centre and 49 were referred from other healthcare services. Cohorts were analysed with regards to differences in therapy and outcomes. Mortality was higher in the direct cohort (74% vs. 34% at discharge, p. 0,001). Factors associated with mortality were increasing age and hypertension, deviating pH, BE and lactate- values, as well as severe cardiovascular disease upon admission. The most common cause of shock was acute myocardial infarction (45%). The groups differed significantly in underlying aetiologies of shock, with higher incidence of out-of- hospital cardiac arrest (OHCA) in the direct transfer cohort (15 vs. 5 pt., p. <0.001), and decompensated heart failure (p. 0.006), cardiomyopathies and NSTEMI in the indirect transfers. Patients in the transferred cohort had a median patient delay in contacting health services of nearly 14 hours (8 vs. 830 minutes, p. <0,001). The transferred cohort also took longer to receive definite treatment after contacting health services, on average 2,7 hours longer than the direct group (139 minutes vs. 303 minutes, p. <0,001). Time to treatment was not a predictor of mortality. Overall use of PCI in the population of 64%, 73% in the direct cohort compared to 55% in the indirect transfer cohort. There was a low usage rate of thrombolysis overall (15 patients, 19%), with little variance between the groups. There was similar usage of supportive treatment (ECMO, IABP) between the groups. Direct transfer patients had an average hospitalization of 3,5 days compared to 15 in the indirect transfers (p. 0,028) <p>Conclusion: Direct admission and transfers emerge as two distinct cohorts in our cardiogenic shock population. These groups had significant different aetiologies, different course of disease, partly different treatments, and somewhat different outcomes. This will be a basis for designing a new pre- and intrahospital treatment algorithm for our “hub and spoke-network”.