Outcomes/Effectiveness Research

Studies explore rapid treatment of sepsis and cardiac arrest

Two new studies investigate whether swift responses for treating sepsis and cardiac arrest are beneficial for patients. Both studies, led by Henry E. Wang, M.D., M.S., of the University of Alabama at Birmingham, and supported in part by the Agency for Healthcare Research and Quality (HS13628), are summarized below.

Wang, H.E., Weaver, M.D., Shapiro, N. I., and Yealy, D. M. (2010, February). "Opportunities for emergency medical services care of sepsis." Resuscitation 81(2), pp. 193-197.

This new study finds that emergency medical services (EMS) personnel may serve as an important resource for early diagnosis and treatment of sepsis, which can lead to organ failure, shock, and death. Of the 4,613 patients suffering from infections who were treated for sepsis at a Boston hospital's emergency department, more than a third were brought there by EMS crews. The EMS-transported patients were almost four times more likely to have severe sepsis or septic shock. Further, two-thirds of the patients who died of sepsis were brought to the hospital via EMS. If EMS personnel added other life-saving services to their sepsis resuscitation protocols, they might be able to improve survival for patients who are severely ill from sepsis, the authors suggest. For example, EMS personnel could add taking a patient's temperature and using a lactate detector to detect shock to the protocols that currently include providing intravenous fluids; administering medication to raise blood pressure, which can drop precipitously in septic shock; and ventilating the patient.

Wong, M.L., Carey, S., Mader, T.J., Patrick, A. R., and Wang, H.E. (2010, February). "Time to invasive airway placement and resuscitation outcomes after inhospital cardiopulmonary arrest." Resuscitation 81(2), pp. 182-186.

When a patient experiences cardiopulmonary arrest (CPA) in a hospital, teams respond swiftly to open an airway, provide chest compressions, and administer drugs to get the patient's heart beating on its own again. A new study finds that opening an airway through endotracheal intubation, laryngeal mask airway placement, tracheostomy, or cricothyridotomy within 5 minutes, as guidelines recommend, may not be necessary. Researchers examined registry data for 25,006 cases of CPA that occurred in the United States, Canada, and Germany. They found that 10,956 patients had invasive airways placed within 5 minutes of CPA (early placement) and 14,050 had airways placed after 5 minutes (late placement). Neither early nor late placement was associated with the return of the patient's heartbeat. The authors suggest that clinicians striving to revive a patient's heart can delay or even avoid placing an airway. In fact, by trying to establish an airway, teams may actually be preventing the use of more important life-saving measures such as providing chest compressions or life-saving drugs.

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