Clinical predictors of outcomes in patients undergoing emergency air medical transport from Kinmen to Taiwan.

Emergency air medical transport (EAMT) is indispensable for acutely or critically ill patients in remote areas. We determined patient-level and transport-specific factors associated with all-cause mortality after EAMT.We conducted a population-based, retrospective cohort study using a prospective registry consisting of clinical/medical records. Study inclusion criteria consisted of all adults undergoing EAMT from Kinmen hospital to the ED of Taipei Veterans General Hospital (TVGH) between January 1, 2006 and December 31, 2012. The primary outcome assessments were 7-day and 30-day mortality.A total of 370 patients transported to TVGH were enrolled in the study with a mean age of 54.5 ±â€Š21.5 (SD) years and with a male predominance (71.6%). The average in-transit time was 1.4 ±â€Š0.4 hours. The 7-day, 30-day, and in-hospital mortality rates were 10.3%, 14.1%, and 14.9%. Among them 33.5% (124/370) were categorized under neurological etiologies, whereas 24.9% (90/370) cardiovascular, followed by 16.2% (60/370) trauma patients. Independent predictors associated with 7-day all-cause mortality were age (odds ratio [OR] 1.043, 95% confidence interval [CI] 1.016-1.070), Glasgow Coma Scale (GCS) (OR 0.730, 95% CI 0.650-0.821), and hematocrit level (OR 0.930, 95% CI 0.878-0.985). Independent predictors associated with 30-day all-cause mortality were age (OR 1.028, 95% CI 1.007-1.049), GCS (OR 0.686, 95% CI 0.600-0.785), hematocrit (OR 0.940, 95% CI 0.895-0.988), hemodynamic instability (OR 5.088 95% CI 1.769-14.635), and endotracheal intubation (OR 0.131 95% CI 0.030-0.569). The 7-day and 30-day mortality were not significantly related to transport-specific factors, such as length of flight, type of paramedic crew on board, or day and season of transport. Clinical patient-level factors, as opposed to transport-level factors, were associated with 7- and 30-day all-cause mortality in patients undergoing interfacility EAMT from Kinmen to Taiwan.

Emergency department critical care unit for critically ill cardiovascular patients: An observation study.

BACKGROUND: We investigated an intensive care model for acute critically cardiovascular emergency patients in the emergency department (ED) as compared with those in the coronary care unit (CCU) after ED visits. METHODS: We performed a retrospective cohort analysis of patients with acute cardiovascular emergency admitted to the intensive care unit in the ED (EICU) or CCU from January 1, 2010 to March 31, 2011 in an university-affiliated medical center. All clinical characteristics or predictors possibly related to in-hospital mortality were documented, completed, and measured via electronic medical records review. The clinical independent variables with p < 0.1 in univariate analysis were further analyzed by using multiple logistic regression. Survival analysis of the predictors for hospital mortality was assessed by Kaplan-Meier survival curves. RESULTS: A total of 964 patients were recruited in this study. Of all patients, 328 were enrolled in the EICU group, whereas 636 were enrolled in the CCU group. Multiple regression analysis of both EICU and CCU mortality demonstrated that Acute Physiology and Chronic Health Evaluation II scores were common predictors of mortality in both groups of patients. Based on these scores, Kaplan-Meier survival curves showed no statistically significant differences of cumulative survival rates in both the 7-day and in-hospital survival between both groups. CONCLUSION: Our study demonstrated a feasible and qualified model of intensive care delivery accomplished by collaboration of emergency physicians and cardiologists for acute critically ill cardiovascular emergency patients after initial ED management. Our results suggest that an expanded multicenter study should be conducted to further test and confirm this intriguing model.