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Care at critical care medical centers is associated with improved outcomes in patients with accidental hypothermia: a historical cohort study from the J‐Point registry

AIM: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear. METHODS: This was a multicenter retrospective cohort study of patients with a body tem...

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Detalles Bibliográficos
Autores principales: Fujimoto, Yoshihiro, Matsuyama, Tasuku, Morita, Sachiko, Ehara, Naoki, Miyamae, Nobuhiro, Okada, Yohei, Jo, Takaaki, Sumida, Yasuyuki, Okada, Nobunaga, Watanabe, Makoto, Nozawa, Masahiro, Tsuruoka, Ayumu, Okumura, Yoshiki, Kitamura, Tetsuhisa, Takegami, Tetsuro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: John Wiley and Sons Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7590663/
https://www.ncbi.nlm.nih.gov/pubmed/33133614
http://dx.doi.org/10.1002/ams2.578
Descripción
Sumario:AIM: The recommendation that patients with accidental hypothermia should be transported to specialized centers that can provide extracorporeal life support has not been validated, and the efficacy remains unclear. METHODS: This was a multicenter retrospective cohort study of patients with a body temperature of ≤35°C presenting at the emergency department of 12 hospitals in Japan between April 2011 and March 2016. We divided the patients into two groups based on the point of care delivery: critical care medical center (CCMC) or non‐CCMC. The primary outcome of this study was in‐hospital death. In‐hospital death was compared using a multivariable logistic regression analysis. Subgroup analyses were carried out according to patients with severe hypothermia (<28°C) or systolic blood pressure (sBP) of <90 mmHg. RESULTS: A total of 537 patients were included, 413 patients (76.9%) in the CCMC group and 124 patients (23.1%) in the non‐CCMC group. The in‐hospital death rate was lower in the CCMC group than in the non‐CCMC group (22.3% versus 31.5%, P < 0.001). The multivariable logistic regression analysis showed that the adjusted odds ratio (AOR) of the CCMC group was 0.54 (95% confidence interval, 0.32–0.90). In subgroup analyses, patients with systolic blood pressure <90 mmHg in the CCMC group were less likely to experience in‐hospital death (AOR 0.36; 95% CI, 0.23–0.56). However, no such association was observed among patients with severe hypothermia (AOR 1.08; 95% CI, 0.63–1.85). CONCLUSIONS: Our multicenter study indicated that care at a CCMC was associated with improved outcomes in patients with accidental hypothermia.