EMS provider management of patients with sepsis
| Study | Measures evaluated | Outcomes measured (results) | Key findings |
|---|---|---|---|
| Baez et al23 | T, HR, MAP, RR, SI, glucose | ICU admission (68%), mortality (35%), mean ventilator days (4.93), ICU days (7) | Abnormal prehospital SI (HR/SBP) and RR predict ICU admission. No correlation to mortality |
| Band et al24 | Time to initial AB administration, time to initial IVF administration | Time to initial ABs (116 vs 152 min) Time to initial IVF (34 vs 68 min) Adjusted relative risk for mortality (1.24 vs 1.66; NS) | Arrival in the emergency department by EMS shortens time to initiation of AB and IVF |
| Femling et al25 | Characteristics of EMS patients with sepsis compared with walk-in patients | Described EMS patient characteristics. Time to ABs was shorter for EMS patients (87 vs 120 min, p=0.02) Impact of EMS interventions (transport, total fluid given) on mortality (NS) | EMS patients were older, had more severe illness and met more SIRS on arrival EMS transport decreased time to ABs EMS interventions showed no association with decreased patient mortality |
| Groenewoudt et al19 | Characteristics of EMS patients with sepsis, EMS provider documentation of sepsis | EMS patient severity of illness and mortality, EMS provider management | Nearly half of septic patients arrive in the emergency department by EMS, most were not considered urgent transports, routine vital signs intervention was not seen |
| Seymour et al21 22 | Receiving prehospital fluid, patients for whom resuscitation goals were achieved within 6 h | Prehospital receipt of IVF (48%) MAP≥65 mm Hg achieved (70% vs 44%; NS) CVP≥8 cm H2O achieved (72% vs 60%; NS) SCVO2≥70% achieved (54% vs 36%; NS) | Less than half of patients with severe sepsis received IVF by EMS Prehospital receipt of IVF shows a trend towards significant improvement in achieving EGDT goals by 6 h |
| Seymour et al21 22 | SBP, HR, GCS, RR, SpO2, delivery of IVF | Abnormal measures associated with increased serum lactate (SBP, GCS, SpO2) Abnormal measures associated with increased SOFA score (SBP, GCS, RR, SpO2) Patients who received fluid in shock (38%) | Routine prehospital-measured clinical variables are associated with increased serum lactate and SOFA scores. Less than half of patients with severe sepsis received IVF by EMS Mortality of EMS patient with sepsis (24%) |
| Seymour et al20 | Venous catheter placement by EMS, IVF resuscitation by EMS | Mortality, organ failures, ICU admission | Venous catheter placement odds of death (OR=0.3, 95% CI 0.17 to 0.57) IVF administration odds of death (OR=0.46, 95% CI 0.23 to 0.88) |
| Wang et al11 | Characteristics of EMS patients with sepsis | Patients with sepsis transported by EMS (34%) Odds of initial EMS care of patients with severe sepsis (3.9) and patients with septic shock (3.6) Adjusted mortality in EMS patients (OR=1.8) | EMS initially cares for large proportion of patients with sepsis EMS initially cares for more patients with severe sepsis and more patients with septic shock |
AB, antibiotic; CVP, central venous pressure; EGDT, early goal directed treatment; EMS, emergency medical services; HR, heart rate; ICU, intensive care unit; IVF, intravenous fluid; MAP, mean arterial pressure; NS, not significant; SBP, systolic BP; SCVO2, central venous oxygen saturation; SI, Shock Index; SIRS, systemic inflammatory response syndrome; SOFA, sequential organ failure assessment; SpO2, oxygen saturation; T, temperature.