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Solà-Muñoz S, Jiménez-Fàbrega X. Long-term prognosis in pre-hospital emergency care is feasible and useful. Emergencias 2024; 36:81-82. [PMID: 38597613 DOI: 10.55633/s3me/013.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Affiliation(s)
- Silvia Solà-Muñoz
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España. Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, España
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, España. Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, España. Universitat de Barcelona, Barcelona, España
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García-Vilana S, Kumar V, Kumar S, Barberia E, Landín I, Granado-Font E, Solà-Muñoz S, Jiménez-Fàbrega X, Bardají A, Hardig BM, Azeli Y. Study of risk factors for injuries due to cardiopulmonary resuscitation with special focus on the role of the heart: A machine learning analysis of a prospective registry with multiple sources of information (ReCaPTa Study). Resusc Plus 2024; 17:100559. [PMID: 38586866 PMCID: PMC10995644 DOI: 10.1016/j.resplu.2024.100559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/11/2023] [Accepted: 01/12/2024] [Indexed: 04/09/2024] Open
Abstract
Background The study of thoracic injuries and biomechanics during CPR requires detailed studies that are very scarce. The role of the heart in CPR biomechanics has not been determined. This study aimed to determine the risk factors importance for serious ribcage damage due to CPR. Methods Data were collected from a prospective registry of out-of-hospital cardiac arrest between April 2014 and April 2017. This study included consecutive out-of-hospital CPR attempts undergoing an autopsy study focused on CPR injuries. Cardiac mass ratio was defined as the ratio of real to expected heart mass. Pearson's correlation coefficient was used to select clinically relevant variables and subsequently classification tree models were built. The Gini index was used to determine the importance of the associated serious ribcage damage factors. The LUCAS® chest compressions device forces and the cardiac mass were analyzed by linear regression. Results Two hundred CPR attempts were included (133 manual CPR and 67 mechanical CPR). The mean age of the sample was 60.4 ± 13.5, and 56 (28%) were women. In all, 65.0% of the patients presented serious ribcage damage. From the classification tree build with the clinically relevant variables, age (0.44), cardiac mass ratio (0.26), CPR time (0.22), and mechanical CPR (0.07), in that order, were the most influential factors on serious ribcage damage. The chest compression forces were greater in subjects with higher cardiac mass. Conclusions The heart plays a key role in CPR biomechanics being cardiac mass ratio the second most important risk factor for CPR injuries.
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Affiliation(s)
- Silvia García-Vilana
- Universitat Politècnica de Catalunya (UPC-EPSEVG), Grup de Recerca Aplicada en Biomecànica de l’Impacte (GRABI), Barcelona, Spain
| | - Vikas Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Saurav Kumar
- Environmental Engineering Laboratory, Departament d' Enginyeria Quimica, Universitat Rovira i Virgili (URV), Tarragona, Spain
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
| | - Eneko Barberia
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Inés Landín
- Institut de Medicina Legal i Ciencies Forenses de Catalunya (IMLCFC), Spain
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
| | - Ester Granado-Font
- Centre d'Atenció Primària Horts de Miró (Reus-4), Institut Català de Salut, Reus, Spain
- Unitat de Suport a la Recerca Tarragona-Reus, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, Spain
| | - Silvia Solà-Muñoz
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
| | - Xavier Jiménez-Fàbrega
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Facultat de Ciencies Mèdiques, Universitat de Barcelona, Spain
| | - Alfredo Bardají
- Facultat de Ciencies Mèdiques, Universitat Rovira i Virgili (URV), Reus, Spain
- Cardiology Department, Joan XXIII, University Hospital, Tarragona, Spain
| | - Bjarne Madsen Hardig
- Department of Clinical Sciences, Helsingborg, Medical Faculty, Lund University, Sweden
| | - Youcef Azeli
- Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona. Spain
- Sistema d’Emergències Mèdiques de Catalunya, Spain
- Emergency Department, Sant Joan University Hospital, Reus, Spain
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Solà-Muñoz S, Jorge M, Jiménez-Fàbrega X, Jiménez-Delgado S, Azeli Y, Marsal JR, Jordán S, Mauri J, Jacob J. Prehospital stratification and prioritisation of non-ST-segment elevation acute coronary syndrome patients (NSTEACS): the MARIACHI scale. Intern Emerg Med 2023; 18:1317-1327. [PMID: 37131092 DOI: 10.1007/s11739-023-03274-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/11/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The objective of this study was to develop and validate a risk scale (MARIACHI) for patients classified as non-ST-segment elevation acute coronary syndrome (NSTEACS) in a prehospital setting with the ability to identify patients at an increased risk of mortality at an early stage. METHODS A retrospective observational study conducted in Catalonia over two periods: 2015-2017 (development and internal validation cohort) and Aug 2018-Jan 2019 (external validation cohort). We included patients classified as prehospital NSTEACS, assisted by an advanced life support unit and requiring hospital admission. The primary outcome was in-hospital mortality. Cohorts were compared using logistic regression and a predictive model was created using bootstrapping techniques. RESULTS The development and internal validation cohort included 519 patients. The model is composed of five variables associated with hospital mortality: age, systolic blood pressure, heart rate > 95 bpm, Killip-Kimball III-IV and ST depression ≥ 0.5 mm. The model showed good overall performance (Brier = 0.043) and consistency in discrimination (AUC 0.88, 95% CI 0.83-0.92) and calibration (slope = 0.91; 95% CI 0.89-0.93). We included 1316 patients for the external validation sample. There was no difference in discrimination (AUC 0.83, 95% CI 0.78-0.87; DeLong Test p = 0.071), but there was in calibration (p < 0.001), so it was recalibrated. The finally model obtained was stratified and scored into three groups according to the predicted risk of patient in-hospital mortality: low risk: < 1% (-8 to 0 points), moderate risk: 1-5% (+ 1 to + 5 points) and high risk: > 5% (6-12 points). CONCLUSION The MARIACHI scale showed correct discrimination and calibration to predict high-risk NSTEACS. Identification of high-risk patients may help with treatment and low referral decisions at the prehospital level.
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Affiliation(s)
| | - Morales Jorge
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Universitat de Barcelona, Barcelona, Spain
| | | | - Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
- Emergency Department, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
- Institut d'Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain
| | - J Ramon Marsal
- RTI Health Solutions, Research Triangle Park, Spain
- Epidemiology Unit of the Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sara Jordán
- Sistema d'Emergències Mèdiques de Catalunya, Catalonia, Spain
| | - Josepa Mauri
- Cardiology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
- Pla Director de Malalties Cardiovasculars (PDMCV), Health Department of the Government of Catalonia, Catalonia, Spain
| | - Javier Jacob
- Universitat de Barcelona, Barcelona, Spain
- Emergency Department, Hospital Universitari de Bellvitge, Barcelona, Spain
- IDIBELL, L'Hospitalet de Llobregat, Spain
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Jiménez-Fàbrega X, Jacob J. Pre- and postpandemic emergency services: similarities and differences. Emergencias 2023; 35:142-145. [PMID: 37038946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Affiliation(s)
| | - Javier Jacob
- Plan Nacional de Urgencias de Cataluña (PLANUC), Barcelona, España
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Azeli Y, Solà-Muñoz S, Soto-García MÁ, Morales-Alvarez J, López-Canela À, Trenado J, Jiménez-Fàbrega X. A Regional Command Center for Pandemic Surge. Chest 2022; 162:1306-1309. [PMID: 35764164 PMCID: PMC9293397 DOI: 10.1016/j.chest.2022.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 06/11/2022] [Accepted: 06/18/2022] [Indexed: 12/14/2022] Open
Affiliation(s)
- Youcef Azeli
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Institut d’Investigació Sanitària Pere i Virgili (IISPV), Tarragona, Spain,Red de Investigación en Emergencias Prehospitalarias (RINVEMER), Madrid, Spain,CORRESPONDENCE TO: Youcef Azeli, MD, PhD
| | - Silvia Solà-Muñoz
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Red de Investigación en Emergencias Prehospitalarias (RINVEMER), Madrid, Spain
| | | | | | | | - José Trenado
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Servei de Medicina Intensiva UCI-Semicritics, Hospital Universitari Mutua de Terrassa, Terrassa, Barcelona, Spain,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d’Emergències Mèdiques de Catalunya, Barcelona, Spain,Red de Investigación en Emergencias Prehospitalarias (RINVEMER), Madrid, Spain,Faculty of Medicine, University of Barcelona, Barcelona, Spain
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Font MÀ, García-Sánchez SM, Mengual JJ, Mena L, Avellaneda C, Serena J, Valls-Carbó A, Chamorro Á, Ustrell X, Molina C, Cardona P, Guasch-Jiménez M, Purroy F, Rodríguez-Campello A, Palomeras E, Cocho D, Krupinski J, Cánovas D, García-Alhama J, Zaragoza J, Puiggròs E, Matos N, Aragonès JM, Costa X, Sanjurjo E, Pedroza C, Monedero J, Almendros MC, Rybyeva M, Carrión D, Díaz G, Barceló M, Jiménez-Fàbrega X, Salvat-Plana M, Elosúa R, Pérez de la Ossa N, Gómez-Choco M. Determinants and Trends of the Use of Intravenous Thrombolysis for Minor Stroke: A Population-Based Study, 2016 to 2020. Stroke 2022; 53:3289-3294. [PMID: 35946402 DOI: 10.1161/strokeaha.122.038996] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND We analyzed the main factors associated with intravenous thrombolysis (IVT) in patients with minor ischemic stroke. METHODS Data were obtained from a prospective, government-mandated, population-based registry of stroke code patients in Catalonia (6 Comprehensive Stroke Centers, 8 Primary Stroke Centers, and 14 TeleStroke Centers). We selected patients diagnosed with ischemic stroke and National Institutes of Health Stroke Scale (NIHSS) ≤5 at hospital admission from January 2016 to December 2020. We excluded patients with a baseline modified Rankin Scale score of ≥3, absolute contraindication for IVT, unknown stroke onset, or admitted to hospital beyond 4.5 after stroke onset. The main outcome was treatment with IVT. We performed univariable and binary logistic regression analyses to identify the most important factors associated with IVT. RESULTS We included 2975 code strokes; 1433 (48.2%) received IVT of which 30 (2.1%) had a symptomatic hemorrhagic transformation. Patients treated with IVT as compared to patients who did not receive IVT were more frequently women, had higher NIHSS, arrived earlier to hospital, were admitted to a Comprehensive Stroke Centers, and had large vessel occlusion. After binary logistic regression, NIHSS score 4 to 5 (odds ratio, 40.62 [95% CI, 31.73-57.22]; P<0.001) and large vessel occlusion (odds ratio, 16.39 [95% CI, 7.25-37.04]; P<0.001) were the strongest predictors of IVT. Younger age, female sex, baseline modified Rankin Scale score of 0, earlier arrival to hospital (<120 minutes after stroke onset), and the type of stroke center were also independently associated with IVT. The weight of large vessel occlusion on IVT was higher in patients with lower NIHSS. CONCLUSIONS Minor stroke female patients, with higher NIHSS, arriving earlier to the hospital, presenting with large vessel occlusion and admitted to a Comprehensive Stroke Centers were more likely to receive intravenous thrombolysis.
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Affiliation(s)
- Maria Àngels Font
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.).,Consorci Hospitalari de Vic, Spain (M.A.F., J.M.A.).,Escola de Doctorat, UVIC-UCC, Spain (M.A.F.)
| | - Sonia María García-Sánchez
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.)
| | - Juan José Mengual
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.)
| | - Luis Mena
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.)
| | - Carla Avellaneda
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.)
| | - Joaquín Serena
- Hospital Universitari Josep Trueta, Girona, Spain (J.S.)
| | - Adrián Valls-Carbó
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.V.-C., N.P.d.l.O.)
| | | | - Xavier Ustrell
- Hospital Universitari Joan XXIII, Tarragona, Spain (X.U.)
| | - Carlos Molina
- Hospital Universitari Vall d'Hebron, Barcelona, Spain (C.M.)
| | - Pere Cardona
- Hospital Universitari de Bellvitge, L'Hospitalet de llobregat, Spain (P.C.)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mercè Salvat-Plana
- Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Barcelona, Spain (M.S.-P., N.P.d.l.O.).,Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS) (M.S.-P.).,CIBER en Epidemiología y Salud Pública (CIBERESP) (M.S.-P.)
| | - Roberto Elosúa
- Universitat de Vic-Universitat Central de Catalunya, Barcelona, Spain (R.E.).,IMIM - Institut Hospital del Mar d'Investigacions Mèdiques, Barcelona, Spain (R.E.).,CIBER Cardiovascular Diseases, Instituto de Salud Carlos III, Madrid, Spain (R.E.)
| | - Natalia Pérez de la Ossa
- Hospital Universitari Germans Trias i Pujol, Badalona, Spain (A.V.-C., N.P.d.l.O.).,Pla Director de la Malaltia Vascular Cerebral, Departament de Salut, Barcelona, Spain (M.S.-P., N.P.d.l.O.)
| | - Manuel Gómez-Choco
- Complex Hospitalari Moisès Broggi, Sant Joan Despí, Spain (M.A.F., S.M.G.-S., J.J.M., L.M., C.A., M.G.-C.)
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Mateo-Rodríguez I, Knox EC, Ruiz-Azpiazu JI, Fernández Del Valle P, Daponte-Codina A, Jiménez-Fàbrega X, Navalpotro-Pascual JMª, Iglesias-Vázquez JA, Echarri-Sucunza A, Alonso-Moreno D, Forner-Canos AB, García-Ochoa Blanco MªJ, Del Pozo-Pérez C, Mainar-Gómez B, Batres-Gómez S, Cortés-Ramas JA, Ceniceros-Rozalén MªI, Guirao-Salinas FÁ, Fernández-Martínez B, Mora MÁ, Carriedo-Scher C, Bragado-Blas MªL, Mellado-Vergel FJ, Rosell-Ortiz F. Persistent gender gaps in out-of-hospital cardiac arrest in Spain from 2013 through 2018. Emergencias 2022; 34:259-267. [PMID: 35833764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To examine gender-related differences in the management and survival of out-of-hospital cardiac arrest (OHCA) in Spain during 2 time series. MATERIAL AND METHODS Analysis of data recorded in the prospective Spanish OHCA registry (OHSCAR in its Spanish acronym) for 2 time series (2013-2014 and 2017-2018). We included all 11 036 consecutive cases in which an emergency team intervened. The dependent variables were arrival at the hospital after return of spontaneous circulation, overall survival to discharge, and overall survival with good neurological outcomes. Sex was the independent variable. We report descriptive statistics, patient group comparisons, and changes over time. RESULTS Women were significantly older and less likely to experience an OHCA in a public place, receive automatic external defibrillation, have a shockable heart rhythm, and be attended by an ambulance team within 15 minutes. In addition, fewer women underwent percutaneous coronary interventions or received treatment for hypothermia on admission to the hospital. In 2013-2014 and 2017-2018, respectively, the likelihood of survival was lower for women than men on admission (odds ratio [OR], 0.52 vs OR, 0.61; P .001 and P = .009 in the 2 time series) and at discharge (OR, 0.69 vs 0.72 for men; P = .001 in both time series). Survival with good neurological outcomes was also less likely in women (OR, 0.50 vs 0.63; P .001 in both series). CONCLUSION The odds for survival and survival with good neurological outcomes were lower for women in nearly all patient groups in both time series. These findings suggest the need to adopt new approaches to address gender differences in OHCA.
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Affiliation(s)
- Inmaculada Mateo-Rodríguez
- Escuela Andaluza de Salud Pública, Granada, España. Universidad Nacional de Educación a Distancia (UNED), Madrid, España
| | - Emily C Knox
- CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
| | | | | | - Antonio Daponte-Codina
- Escuela Andaluza de Salud Pública, Granada, España. CIBER de Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III, Madrid, España
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Soteras Í, Ayala M, Subirats E, Trullàs JC, Jiménez-Fàbrega X. Acute mountain sickness. Is its prevalence overestimated? Rev Clin Esp 2022; 222:S2254-8874(22)00039-X. [PMID: 35577704 DOI: 10.1016/j.rceng.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/16/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Í Soteras
- Departamento de Ciencias Médicas, Universitat de Girona, Girona, Spain; Servicio de Urgencias, Hospital de Cerdanya, Puigcerdà, Girona, Spain
| | - M Ayala
- Unidad de Cuidados Intensivos, Hospital Nostra Senyora de Meritxell, Escaldes, Les Escaldes, Andorra
| | - E Subirats
- Departamento de Ciencias Médicas, Universitat de Girona, Girona, Spain
| | - J C Trullàs
- Departamento de Ciencias Médicas, Universitat de Girona, Girona, Spain; Servicio de Medicina Interna, Hospital d'Olot i Comarcal de la Garrotxa, Olot, Girona, Spain
| | - X Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques (SEM) de Catalunya, Miembro de la Red de Investigación Rinvemer (SEMES), Spain.
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Solà-Muñoz S, Yuguero O, Azeli Y, Roig G, Prieto-Arruñada JA, Español J, Morales-Álvarez J, Muñoz M, Verge JJ, Jiménez-Fàbrega X. Impact on polytrauma patient prehospital care during the first wave of the COVID-19 pandemic: a cross-sectional study. Eur J Trauma Emerg Surg 2021; 47:1351-1358. [PMID: 34331073 PMCID: PMC8324448 DOI: 10.1007/s00068-021-01748-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
Background The extraordinary situation caused by the onset of COVID-19 has meant that at prehospital level, the number of treatments, profile and time taken to respond for treating time-dependent pathologies has been greatly affected. However, it is not known whether the prehospital profile of polytrauma patients (PTP) has been affected. Objective To determine differences in the epidemiological characteristics and the clinical variables of prehospital polytrauma patients during the first wave of the COVID-19 pandemic in Catalonia. Methodology Analytical cross-sectional study. The number of prehospital activations and the clinical and epidemiological characteristics of polytrauma patients attended by the Emergency Medical System (EMS) of Catalonia, were compared for the period between 15 February and 15 May 2020 and the same period in the previous year. Priorities 0 and 1 are assigned to the most severely injured patients. An analysis was conducted using logistic regression and nonparametric tests. Results 3023 patients were included. During the 2019 study period, 2045 (67.6%) patients were treated; however, during the pandemic period, 978 (32.4%) patients were treated, representing a 52% decrease (p = 0.002). The percentage of patients presenting priority 1 was higher during the pandemic period [240 (11.7%) vs 146 (14.9%), p = 0.032]. The percentage of priority 0 and 1 patients attended by a basic life support unit increased [201 (9.8%) vs 133 (13.6%), p = 0.006]. The number of traffic accidents decreased from 1211 (59.2%) to 522 (53.4%) and pedestrian-vehicle collisions fell from 249 (12.2%) to 92 (9.4%). Regarding weapon-related injuries and burns, there was an increase in the number of cases [43 (2.1%) vs 41 (4.2%), and 15 (0.7%) vs 22 (2.2%), p = 0.002 and p < 0.001, respectively]. Hospital mortality remained unchanged (3.9%). Conclusions During the first wave of the pandemic, the number of polytrauma patients decreased and there was a change in the profile of severity and type of accident.
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Affiliation(s)
- Silvia Solà-Muñoz
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain.,Red de Investigación Emergencias Prehospitalarias (RINVEMER), Madrid, Spain
| | - Oriol Yuguero
- Transversal Research Group on Emergencies. IRBLLEIDA, AVda. Rovira Roure 80, 25198, Lleida, Spain. .,Faculty of Medicine, University of Lleida, Lleida, Spain.
| | - Youcef Azeli
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain.,Institut d'Investigació Sanitari Pere i Virgili (IISPV), Tarragona, Spain.,Hospital Universitari Sant Joan de Reus, Tarragona, Spain
| | - Guillermo Roig
- Faculty of Medicine, University of Lleida, Lleida, Spain
| | | | - Jaume Español
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain
| | | | - Manuel Muñoz
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain
| | - Juan José Verge
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain
| | - Xavier Jiménez-Fàbrega
- Sistema d'Emergències Mèdiques de Catalunya, Barcelona, Spain.,Red de Investigación Emergencias Prehospitalarias (RINVEMER), Madrid, Spain
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Ramos-Pachón A, García-Tornel Á, Millán M, Ribó M, Amaro S, Cardona P, Martí-Fàbregas J, Roquer J, Silva Y, Ustrell X, Purroy F, Gómez-Choco M, Zaragoza-Brunet J, Cánovas D, Krupinski J, Sala NM, Palomeras E, Cocho D, Redondo L, Repullo C, Sanjurjo E, Carrión D, López M, Almendros MC, Barceló M, Monedero J, Catena E, Rybyeba M, Diaz G, Jiménez-Fàbrega X, Solà S, Hidalgo V, Pueyo MJ, Pérez de la Ossa N, Urra X. Bottlenecks in the Acute Stroke Care System during the COVID-19 Pandemic in Catalonia. Cerebrovasc Dis 2021; 50:551-559. [PMID: 34023822 PMCID: PMC8247826 DOI: 10.1159/000516309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 04/02/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic resulted in significant healthcare reorganizations, potentially striking standard medical care. We investigated the impact of the COVID-19 pandemic on acute stroke care quality and clinical outcomes to detect healthcare system's bottlenecks from a territorial point of view. METHODS Crossed-data analysis between a prospective nation-based mandatory registry of acute stroke, Emergency Medical System (EMS) records, and daily incidence of COVID-19 in Catalonia (Spain). We included all stroke code activations during the pandemic (March 15-May 2, 2020) and an immediate prepandemic period (January 26-March 14, 2020). Primary outcomes were stroke code activations and reperfusion therapies in both periods. Secondary outcomes included clinical characteristics, workflow metrics, differences across types of stroke centers, correlation analysis between weekly EMS alerts, COVID-19 cases, and workflow metrics, and impact on mortality and clinical outcome at 90 days. RESULTS Stroke code activations decreased by 22% and reperfusion therapies dropped by 29% during the pandemic period, with no differences in age, stroke severity, or large vessel occlusion. Calls to EMS were handled 42 min later, and time from onset to hospital arrival increased by 53 min, with significant correlations between weekly COVID-19 cases and more EMS calls (rho = 0.81), less stroke code activations (rho = -0.37), and longer prehospital delays (rho = 0.25). Telestroke centers were afflicted with higher reductions in stroke code activations, reperfusion treatments, referrals to endovascular centers, and increased delays to thrombolytics. The independent odds of death increased (OR 1.6 [1.05-2.4], p 0.03) and good functional outcome decreased (mRS ≤2 at 90 days: OR 0.6 [0.4-0.9], p 0.015) during the pandemic period. CONCLUSION During the COVID-19 pandemic, Catalonia's stroke system's weakest points were the delay to EMS alert and a decline of stroke code activations, reperfusion treatments, and interhospital transfers, mostly at local centers. Patients suffering an acute stroke during the pandemic period had higher odds of poor functional outcome and death. The complete stroke care system's analysis is crucial to allocate resources appropriately.
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Affiliation(s)
| | | | - Mònica Millán
- Stroke Unit, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Marc Ribó
- Hospital Universitari Vall D'Hebron-VHIR, Barcelona, Spain
| | - Sergi Amaro
- Stroke Unit, Hospital Clínic, Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital Universitari Bellvitge, Hospitalet de Llobregat, Spain
| | - Joan Martí-Fàbregas
- Stroke Unit, Department of Neurology, Santa Creu i Sant Pau Hospital, Barcelona, Spain
| | - Jaume Roquer
- Stroke Unit, Department of Neurology, Mar Hospital, Barcelona, Spain
| | - Yolanda Silva
- Stroke Unit, Hospital Universitari Josep Trueta, Girona, Spain
| | - Xavier Ustrell
- Department of Neurology, Hospital Universitari Joan XXIII, Tarragona, Spain
| | - Francisco Purroy
- Department of Neurology, Stroke Unit, Hospital Arnau de Vilanova, Lleida, Spain
| | | | | | - David Cánovas
- Department of Neurology, Hospital Parc Taulí, Sabadell, Spain
| | - Jurek Krupinski
- Department of Neurology, Hospital Mútua Terrassa, Terrassa, Spain
| | - Natalia Mas Sala
- Department of Neurology, Hospital Sant Joan de Déu - Fundació Althaia, Manresa, Spain
| | | | - Dolores Cocho
- Department of Neurology, Hospital General Granollers, Granollers, Spain
| | - Laura Redondo
- Emergency Department, Hospital Universitari Vic, Vic, Spain
| | - Carmen Repullo
- Emergency Department, Fundació Hospital Seu Urgell, La Seu d'Urgell, Spain
| | | | - Dolors Carrión
- Emergency Department, Hospital Mora Ebre, Mora Ebre, Spain
| | - Mercè López
- Emergency Department, Hospital Figueres, Figueres, Spain
| | | | - Miquel Barceló
- Emergency Department, Hospital Cerdanya, Puigcerdà, Spain
| | | | - Esther Catena
- Department of Neurology, Consorci Sanitari Alt Penedès-Garraf, Vilafranca del Penedés, Spain
| | - Maria Rybyeba
- Emergency Department, Fundació Hospital d'Olot, Olot, Spain
| | - Gloria Diaz
- Emergency Department, Hospital Campdevànol, Campdevànol, Spain
| | | | - Silvia Solà
- Sistema d'Emergències Mèdiques, Barcelona, Spain
| | | | | | | | - Xabier Urra
- Stroke Unit, Hospital Clínic, Barcelona, Spain
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Purroy F, Arque G, Mauri G, García-Vázquez C, Vicente-Pascual M, Pereira C, Vazquez-Justes D, Torres-Querol C, Vena A, Abilleira S, Cardona P, Forné C, Jiménez-Fàbrega X, Pagola J, Portero-Otin M, Rodríguez-Campello A, Rovira À, Martí-Fàbregas J. REMOTE Ischemic Perconditioning Among Acute Ischemic Stroke Patients in Catalonia: REMOTE-CAT PROJECT. Front Neurol 2020; 11:569696. [PMID: 33101178 PMCID: PMC7546310 DOI: 10.3389/fneur.2020.569696] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/24/2023] Open
Abstract
Rationale: Remote ischemic perconditioning during cerebral ischemia (RIPerC) refers to the application of brief episodes of transient limb ischemia commonly to a limb, it represents a new safe, simple and low-cost paradigm in neuroprotection. Aim and/or Hypothesis: To evaluate the effects of RIPerC on acute ischemic stroke (AIS) patients, applied in the ambulance, to improve functional outcomes compared with standard of care. Sample Size Estimates: A sample size of 286 patients in each arm achieves 80% power to detect treatment differences of 14% in the outcome, using a two-sided binomial test at significance level of 0.05, assuming that 40% of the control patients will experience good outcome and an initial misdiagnosis rate of 29%. Methods and Design: We aim to conduct a multicentre study of pre-hospital RIPerC application in AIS patients. A total of 572 adult patients diagnosed of suspected clinical stroke within 8 h of symptom onset and clinical deficit >0 according to prehospital rapid arterial occlusion evaluation (RACE) scale score will be randomized, in blocks of size 4, to RIPerC or sham. Patients will be stratified by RACE score scale. RIPerC will be started in the ambulance before hospital admission and continued in the hospital if necessary. It will consist of five cycles of electronic tourniquet inflation and deflation (5 min each). The cuff pressure for RIPerC will be 200 mmHg during inflation. Sham will only simulate vibration of the device. Study Outcome(s): The primary outcome will be the difference in the proportion of patients with good outcomes as defined by a mRS score of 2 or less at 90 days. Secondary outcomes to be monitored will include early neurological improvement rate, treatment related serious adverse event rates, size of the infarct volume, symptomatic intracranial hemorrhage, metabolomic and lipidomic response to RIPerC and Neuropsychological evaluation at 90 days. Discussion: Neuroprotective therapies could not only increase the benefits of available reperfusion therapies among AIS patients but also provide an option for patients who are not candidates for these treatments. REMOTE-CAT will investigate the clinical benefit of RIC as a new neuroprotective strategy in AIS. Clinical Trial Registration:www.ClinicalTrials.gov, identifier: NCT03375762.
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Affiliation(s)
- Francisco Purroy
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gloria Arque
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Gerard Mauri
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina García-Vázquez
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Mikel Vicente-Pascual
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Cristina Pereira
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Daniel Vazquez-Justes
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Coral Torres-Querol
- Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Vena
- Stroke Unit, Department of Neurology, Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain.,Clinical Neurosciences Group, Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Sònia Abilleira
- Stroke Programme, Agency for Health Quality and Assessment of Catalonia, CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Pere Cardona
- Stroke Unit, Hospital de Bellvitge, Hospitalet de Llobregat, Spain
| | - Carles Forné
- Department of Basic Medical Sciences, Universitat de Lleida, Lleida, Spain
| | | | - Jorge Pagola
- Stroke Unit, Neurology Department, Vall d'Hebron Hospital, Barcelona, Spain
| | - Manuel Portero-Otin
- Department of Experimental Medicine, NUTREN-Nutrigenomics, Biomedical Institut de Recerca Biomèdica de Lleida (IRBLleida), Universitat de Lleida, Lleida, Spain
| | - Ana Rodríguez-Campello
- Neurovascular Research Group, Neurology Department, Institut Hospital del Mar d'Investigacions Mèdiques-Hospital del Mar, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology and MRI Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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Belvís R, Cocho D, Martí-Fàbregas J, Pagonabarraga J, Aleu A, García-Bargo MD, Pons J, Coma E, García-Alfranca F, Jiménez-Fàbrega X, Martí-Vilalta JL. Benefits of a Prehospital Stroke Code System. Cerebrovasc Dis 2005; 19:96-101. [PMID: 15608433 DOI: 10.1159/000082786] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Accepted: 08/02/2004] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Hospital admission delay is a main limiting factor for effective thrombolytic therapy in stroke patients. We developed a stroke code system for rapid request of emergency transportation to the hospital and a priority availability of the attending neurologist on the patient's arrival at the Emergency Department (ED). METHODS Over a 1-year period, a 24-hour telephone hotline between the attending neurologist and the Barcelona public emergency coordination service was established. Priority 1 (P1) was defined as a patient with symptoms suggestive of acute stroke with onset of less than 3 h, in which case immediate transportation service and rapid ED reception was organized. Data from patients in the P1 group (n = 39) and patients without activation of the stroke code (P0) (n = 181) were compared. RESULTS There were significant differences between P1 and P0 groups in mean time from ED arrival to request for neurologic assessment (4.4 +/- 19.5 vs. 194.7 +/- 244.9 min, p < 0.001), from arrival to neurologic examination (12.6 +/- 21.1 vs. 225.3 +/- 258.2 min, p < 0.005), and from arrival to performance of brain CT scan (35.5 +/- 34.9 vs.120.3 +/- 143.2 min, p < 0.001), and also in the number of patients treated with thrombolytic agents (19 vs. 4.5%, p < 0.003). There were no differences between groups in the time elapsed from stroke onset to ED arrival. CONCLUSIONS Activation of the stroke code was effective in increasing the percentage of patients treated with thrombolytic drugs and also in shortening the delay from ED arrival until neurologic assessment and from ED arrival until brain CT.
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Affiliation(s)
- Robert Belvís
- Acute Stroke Unit of the Department of Neurology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.
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