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Compagnoni S, Gentile F, Baldi E, Mare C, Primi R, Bendotti S, Currao A, Contri E, Reali F, Bussi D, Facchin F, Centineo P, Savastano S. P30 CARDIAC ARRESTS IN SPORTS: WHAT IS DIFFERENT COMPARED TO OTHER PUBLIC PLACES? Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac012.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Cardiac arrests in sports can involve professional athletes, amateurs, but also spectators of sports competitions. Sports facilities are the only ones for which the current law provides for the presence of an automatic external defibrillator (AED) and trained personnel, unlike other public places (schools, work, street, station, general public buildings) where it is only recommended.
Objective
To compare patient characteristics, presentation rhythm, bystander cardiopulmonary resuscitation (CPR), AED use before emergency medical services (EMS) arrival, and return of spontaneous circulation (ROSC) longer than 30 seconds in the Utstein category of out–of–hospital cardiac arrests (OHCAs) in sports compared to events in other public places.
Materials and Methods
We considered all the OHCAs occurred from 01/01/2015 to 31/12/2020 in the provinces of Pavia, Lodi, Cremona, Mantua and Varese (2400000 inhabitants), excluding the OHCAs occurred at home, in long–term care facilities and witnessed by the EMS.
Results
During the study period, 22 OHCAs occurred in sports and 552 in other public places (school, work, street, station, public buildings). The age is similar in the two groups [sport 59 years (IQR 53.5–66.7) vs other 63 years (IQR 51–75), p = 0.2]. In sports, there is a trend in favor of shockable rhythms (13/22=59% vs 185/552=33%, p = 0.1). The percentage of CPR performed by bystanders in sports is significantly higher than in other public places (20/22=91% vs 299/552=54%, p = 0.003), as the bystander AED use (11/22=50% vs 64/552=12%, p < 0.001) and bystander AED shock (7/22=31% vs 27/552=5%, p < 0.001) before EMS arrival. A ROSC greater than 30 seconds was obtained in 59% of OHCAs in sports, with a statistically significant difference compared to events in other public places (13/22=59% vs 166/552=30%, p = 0.015).
Conclusions
During sports competitions there is a greater ability to intervene in case of cardiac arrest, which determines a higher probability of obtaining ROSC, although in terms of age or presentation rhythm the patients are comparable to OHCA victims in other places public. These results suggest the need for an AED and trained personnel in other public places as well.
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Affiliation(s)
- S Compagnoni
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Gentile
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - E Baldi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - C Mare
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - R Primi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - S Bendotti
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - A Currao
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - E Contri
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Reali
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - D Bussi
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - F Facchin
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - P Centineo
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
| | - S Savastano
- DIVISIONE DI CARDIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; UNITÀ DI TERAPIA INTENSIVA CORONARICA, ARITMOLOGIA ED ELETTROFISIOLOGIA, FONDAZIONE IRCCS POLICLINICO SAN MATTEO, PAVIA; AZIENDA REGIONALE EMERGENZA URGENZA (AREU), MILANO; AAT PAVIA, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), PAVIA; AAT LODI, AZIENDA REGIONALE EMERGENZA URGENZA (AREU), LODI; AAT CREMONA, AZIENDA REGIONALE
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Botteri M, Celi S, Perone G, Prati E, Bera P, Villa GF, Mare C, Sechi GM, Zoli A, Fagoni N. Effectiveness of massive transfusion protocol activation in pre-hospital setting for major trauma. Injury 2022; 53:1581-1586. [PMID: 35000744 DOI: 10.1016/j.injury.2021.12.047] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/16/2021] [Accepted: 12/29/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hemorrhage in major trauma is life-threatening and the activation of the Massive Transfusion Protocol (MTP) was found to reduce the time to transfusion and mortality. The purpose was (i) to verify whether MTP activation identifies patients that require massive transfusions once admitted to the Emergency Department (ED), (ii) to establish whether pre-hospital MTP activation reduces the time to transfusion on arrival at the ED, (iii) to identify the variable that best predicts MTP activation. MATERIALS AND METHODS This is a retrospective, single-center study. The MTP was implemented at the end of 2012; it was activated for major trauma in pre-hospital setting on the basis on established criteria. Pre-hospital MTP activation aimed to make blood products available prior to the patients' arrival at the ED. The blood products are transfused when the patient arrives at the hospital. RESULTS The MTP was activated in pre-hospital setting in 219 patients. On arrival at the hospital, the Trauma Team Leader confirmed MTP activation in 146 (66.7%) patients. Patients with MTP criteria received a higher amount of blood products than the patients without MTP criteria, median 7 (IQR 2-13) units versus 2 (0-6) units, respectively (P < 0.001). At the same time, patients with a Shock Index ≥ 0.9 received more transfusions (5.5 [2-13] units) compared with patients characterized by a lower SI (2 [0-7.25] units, P = 0.009). 146 patients were transfused in the first hour of ED admission. Poisson's multiple regression shows that the SI is the variable that better predicted MTP activation compared to age, gender and the number of injured sites. CONCLUSIONS Pre-hospital MTP activation is useful to identify patients that require an urgent blood transfusion on arrival at the ED. Further analysis should be considered to evaluate the implementation of the Shock Index as a criterion to activate MTP.
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Affiliation(s)
- Marco Botteri
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | - Simone Celi
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | - Giovanna Perone
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | - Enrica Prati
- Immuno-Haematology and Transfusional Medicine Service (SIMT), ASST Spedali Civili University Hospital, Brescia, Italy
| | - Paola Bera
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | | | - Alberto Zoli
- Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy
| | - Nazzareno Fagoni
- AAT Brescia, Agenzia Regionale Emergenza Urgenza (AREU). Department of Anesthesia, Intensive Care and Emergency, ASST Spedali Civili University Hospital, Piazzale Spedali Civili, Brescia 1-25123, Italy; Agenzia Regionale Emergenza Urgenza Headquarters (AREU HQ), Milano, Italy; Department of Molecular and Translational Medicine, University of Brescia, Italy.
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3
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Baldi E, Compagnoni S, Buratti S, Primi R, Bendotti S, Currao A, Gentile FR, Sechi GM, Mare C, Bertona R, Raimondi Cominesi I, Taravelli E, Fava C, Danzi GB, Oltrona Visconti L, Savastano S. Long-Term Outcome After Out-of-Hospital Cardiac Arrest: An Utstein-Based Analysis. Front Cardiovasc Med 2022; 8:764043. [PMID: 34977181 PMCID: PMC8715950 DOI: 10.3389/fcvm.2021.764043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 11/18/2021] [Indexed: 11/24/2022] Open
Abstract
Background: No data are available regarding long-term survival of out-of-hospital cardiac arrest (OHCA) patients based on different Utstein subgroups, which are expected to significantly differ in terms of survival. We aimed to provide the first long-term survival analysis of OHCA patients divided according to Utstein categories. Methods: We analyzed all the 4,924 OHCA cases prospectively enrolled in the Lombardia Cardiac Arrest Registry (Lombardia CARe) from 2015 to 2019. Pre-hospital data, survival, and cerebral performance category score (CPC) at 1, 6, and 12 months and then every year up to 5 years after the event were analyzed for each patient. Results: A decrease in survival was observed during the follow-up in all the Utstein categories. The risk of death of the “all-EMS treated” group exceeded the general population for all the years of follow-up with standardized mortality ratios (SMRs) of 23 (95%CI, 16.8–30.2), 6.8 (95%CI, 3.8–10.7), 3.8 (95%CI, 1.7–6.7), 4.05 (95%CI, 1.9–6.9), and 2.6 (95%CI, 1.03–4.8) from the first to the fifth year of follow-up. The risk of death was higher also for the Utstein categories “shockable bystander witnessed” and “shockable bystander CPR”: SMRs of 19.4 (95%CI, 11.3–29.8) and 19.4 (95%CI, 10.8–30.6) for the first year and of 6.8 (95%CI, 6.6–13) and 8.1 (95%CI, 3.1–15.3) for the second one, respectively. Similar results were observed considering the patients discharged with a CPC of 1–2. Conclusions: The mortality of OHCA patients discharged alive from the hospital is higher than the Italian standard population, also considering those with the most favorable OHCA characteristics and those discharged with good neurological outcome. Long-term follow-up should be included in the next Utstein-style revision.
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Affiliation(s)
- Enrico Baldi
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Stefano Buratti
- Division of Cardiology, Ospedale Civile di Voghera, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Voghera, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Francesca Romana Gentile
- Section of Cardiology, Department of Molecular Medicine, University of Pavia, Pavia, Italy.,Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | - Roberta Bertona
- Division of Cardiology, Ospedale Civile di Vigevano, Azienda Socio-Sanitaria Territoriale (ASST) di Pavia, Vigevano, Italy
| | - Irene Raimondi Cominesi
- Division of Cardiology, Ospedale Maggiore di Lodi, Azienda Socio-Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
| | - Erika Taravelli
- Division of Cardiology, Ospedale Maggiore di Crema, Azienda Socio-Sanitaria Territoriale (ASST) di Crema, Crema, Italy
| | - Cristian Fava
- Division of Cardiology, Ospedale Carlo Poma, Azienda Socio-Sanitaria Territoriale (ASST) di Mantova, Mantova, Italy
| | - Gian Battista Danzi
- Division of Cardiology, Ospedale di Cremona, Azienda Socio-Sanitaria Territoriale (ASST) di Cremona, Cremona, Italy
| | - Luigi Oltrona Visconti
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo, Pavia, Italy
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Baldi E, Primi R, Bendotti S, Currao A, Compagnoni S, Gentile FR, Sechi GM, Mare C, Palo A, Contri E, Ronchi V, Bergamini G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Campi S, Centineo P, De Ponti R, Oltrona Visconti L, Savastano S. Relationship between out-of-hospital cardiac arrests and COVID-19 during the first and second pandemic wave. The importance of monitoring COVID-19 incidence. PLoS One 2021; 16:e0260275. [PMID: 34797840 PMCID: PMC8604324 DOI: 10.1371/journal.pone.0260275] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 11/05/2021] [Indexed: 12/14/2022] Open
Abstract
Background The relationship between COVID-19 and out-of-hospital cardiac arrests (OHCAs) has been shown during different phases of the first pandemic wave, but little is known about how to predict where cardiac arrests will increase in case of a third peak. Aim To seek for a correlation between the OHCAs and COVID-19 daily incidence both during the two pandemic waves at a provincial level. Methods We considered all the OHCAs occurred in the provinces of Pavia, Lodi, Cremona, Mantua and Varese, in Lombardy Region (Italy), from 21/02/2020 to 31/12/2020. We divided the study period into period 1, the first 157 days after the outbreak and including the first pandemic wave and period 2, the second 158 days including the second pandemic wave. We calculated the cumulative and daily incidence of OHCA and COVID-19 for the whole territory and for each province for both periods. Results A significant correlation between the daily incidence of COVID-19 and the daily incidence of OHCAs was observed both during the first and the second pandemic period in the whole territory (R = 0.4, p<0.001 for period 1 and 2) and only in those provinces with higher COVID-19 cumulative incidence (period 1: Cremona R = 0.3, p = 0.001; Lodi R = 0.4, p<0.001; Pavia R = 0.3; p = 0.01; period 2: Varese R = 0.4, p<0.001). Conclusions Our results suggest that strictly monitoring the pandemic trend may help in predict which territories will be more likely to experience an OHCAs’ increase. That may also serve as a guide to re-allocate properly health resources in case of further pandemic waves.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Romana Gentile
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Agenzia Regionale Emergenza Urgenza, Milan, Italy
| | - Alessandra Palo
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Contri
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vincenza Ronchi
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- ASST di Pavia, Pavia, Italy
| | - Giuseppe Bergamini
- AAT Lodi - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Francesca Reali
- AAT Lodi - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Pierpaolo Parogni
- AAT Mantova - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantua, Mantua, Italy
| | - Fabio Facchin
- AAT Mantova - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantua, Mantua, Italy
| | - Ugo Rizzi
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Daniele Bussi
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Sabina Campi
- AAT Varese - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, Varese, Italy
| | - Paola Centineo
- AAT Varese - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST dei Sette Laghi, Varese, Italy
| | - Roberto De Ponti
- ASST-Settelaghi, Ospedale di Circolo - Università dell’Insubria, Varese, Italy
| | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- * E-mail:
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5
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Gentile FR, Primi R, Baldi E, Compagnoni S, Mare C, Contri E, Reali F, Bussi D, Facchin F, Currao A, Bendotti S, Savastano S. Out-of-hospital cardiac arrest and ambient air pollution: a dose-effect relationship and a predictive role in OHCA risk. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Pollution has been suggested as a precipitating factor for cardiovascular diseases via a series of different mechanisms. However, data about the link between the different air pollutants and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial.
Purpose
The primary aim of this study is to examine the impact of short-term exposure to particulate and gaseous pollutants on the incidence of OHCA in a vast metropolitan and rural area that encompasses four provinces of the Po Valley in Northern Italy, one of the most polluted areas in Italy and Europe due to its levels of industrialization and high population density. The secondary aim of this study is to look for a dose-effect curve, which could help predict OHCA incidence based on the concentration of pollutants in a specific area.
Methods
This is a retrospective analysis of prospectively collected data both in the OHCA registry (Lombardia CARe) and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region. All medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2) and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 155ehab724.2654 inhabitants). Days were divided into high or low incidence of OHCA according to the median daily incidence. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant.
Results
The median daily incidence of OHCA was 0.3 cases/100,000 inhabitants. Benzene was the pollutant with the greatest difference between days at high and low incidence of OHCA [0.7 (IQR 0.4–1.2) vs 0.4 (IQR 0.3–0.7), p<0.001], whereas SO2 had the lowest and least significant difference between the two periods [3.2 (IQR 2.8–3.6) vs 3.1 (IQR 2.7–3.5), p=0.046]. O3 showed a countertrend, being significantly higher in the low-incidence period [29.9 (IQR 10.9–61.7) vs 56.1 (IQR 25.5–74.1), p<0.001] as well as temperature [10.1— (IQR 5.2–14.8) vs 15.1 (IQR 8.9–23.3), p<0.001]. By using the Probit regression analysis and after adjusting for temperature, a dose-response relationship was demonstrated for all the tested pollutants.
Conclusions
Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- F R Gentile
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - R Primi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - E Baldi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Compagnoni
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - C Mare
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - E Contri
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - F Reali
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - D Bussi
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - F Facchin
- Agenzia Regionale dell'Emergenza Urgenza, Milano, Italy
| | - A Currao
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Bendotti
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - S Savastano
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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6
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Gentile FR, Primi R, Baldi E, Compagnoni S, Mare C, Contri E, Reali F, Bussi D, Facchin F, Currao A, Bendotti S, Savastano S. Out-of-hospital cardiac arrest and ambient air pollution: A dose-effect relationship and an association with OHCA incidence. PLoS One 2021; 16:e0256526. [PMID: 34432840 PMCID: PMC8386838 DOI: 10.1371/journal.pone.0256526] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Accepted: 08/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Pollution has been suggested as a precipitating factor for cardiovascular diseases. However, data about the link between air pollution and the risk of out-of-hospital cardiac arrest (OHCA) are limited and controversial. Methods By collecting data both in the OHCA registry and in the database of the regional agency for environmental protection (ARPA) of the Lombardy region, all medical OHCAs and the mean daily concentration of pollutants including fine particulate matter (PM10, PM2.5), benzene (C6H6), carbon monoxide (CO), nitrogen dioxide (NO2), sulphur dioxide (SO2), and ozone (O3) were considered from January 1st to December 31st, 2019 in the southern part of the Lombardy region (provinces of Pavia, Lodi, Cremona and Mantua; 7863 km2; about 1550000 inhabitants). Days were divided into high or low incidence of OHCA according to the median value. A Probit dose-response analysis and both uni- and multivariable logistic regression models were provided for each pollutant. Results The concentrations of all the pollutants were significantly higher in days with high incidence of OHCA except for O3, which showed a significant countertrend. After correcting for temperature, a significant dose-response relationship was demonstrated for all the pollutants examined. All the pollutants were also strongly associated with high incidence of OHCA in multivariable analysis with correction for temperature, humidity, and day-to-day concentration changes. Conclusions Our results clarify the link between pollutants and the acute risk of cardiac arrest suggesting the need of both improving the air quality and integrating pollution data in future models for the organization of emergency medical services.
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Affiliation(s)
- Francesca Romana Gentile
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Compagnoni
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Claudio Mare
- Agenzia Regionale dell’Emergenza Urgenza (AREU) Lombardia, Milano, Italy
| | - Enrico Contri
- AAT Pavia - Agenzia Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Reali
- AAT Lodi - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Daniele Bussi
- AAT Cremona - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Fabio Facchin
- AAT Mantova - Agenzia Regionale Emergenza Urgenza (AREU) c/o ASST di Mantua, Mantua, Italy
| | - Alessia Currao
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Sara Bendotti
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- * E-mail:
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7
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Giudici R, Lancioni A, Gay H, Bassi G, Chiara O, Mare C, Latronico N, Pesenti A, Faccincani R, Cabrini L, Fumagalli R, Chieregato A, Briani L, Sammartano F, Sechi G, Zoli A, Pagliosa A, Foti G, Borotto E, Palo A, Valoti O, Botteri M, Carlucci M, Reitano E, Bini R. Impact of the COVID-19 outbreak on severe trauma trends and healthcare system reassessment in Lombardia, Italy: an analysis from the regional trauma registry. World J Emerg Surg 2021; 16:39. [PMID: 34281575 PMCID: PMC8287111 DOI: 10.1186/s13017-021-00383-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022] Open
Abstract
Backgrounds The COVID-19 pandemic drastically strained the health systems worldwide, obligating the reassessment of how healthcare is delivered. In Lombardia, Italy, a Regional Emergency Committee (REC) was established and the regional health system reorganized, with only three hospitals designated as hubs for trauma care. The aim of this study was to evaluate the effects of this reorganization of regional care, comparing the distribution of patients before and during the COVID-19 outbreak and to describe changes in the epidemiology of severe trauma among the two periods. Methods A cohort study was conducted using retrospectively collected data from the Regional Trauma Registry of Lombardia (LTR). We compared the data of trauma patients admitted to three hub hospitals before the COVID-19 outbreak (September 1 to November 19, 2019) with those recorded during the pandemic (February 21 to May 10, 2020) in the same hospitals. Demographic data, level of pre-hospital care (Advanced Life Support-ALS, Basic Life Support-BLS), type of transportation, mechanism of injury (MOI), abbreviated injury score (AIS, 1998 version), injury severity score (ISS), revised trauma score (RTS), and ICU admission and survival outcome of all the patients admitted to the three trauma centers designed as hubs, were reviewed. Screening for COVID-19 was performed with nasopharyngeal swabs, chest ultrasound, and/or computed tomography. Results During the COVID-19 pandemic, trauma patients admitted to the hubs increased (46.4% vs 28.3%, p < 0.001) with an increase in pre-hospital time (71.8 vs 61.3 min, p < 0.01), while observed in hospital mortality was unaffected. TRISS, ISS, AIS, and ICU admission were similar in both periods. During the COVID-19 outbreak, we observed substantial changes in MOI of severe trauma patients admitted to three hubs, with increases of unintentional (31.9% vs 18.5%, p < 0.05) and intentional falls (8.4% vs 1.2%, p < 0.05), whereas the pandemic restrictions reduced road- related injuries (35.6% vs 60%, p < 0.05). Deaths on scene were significantly increased (17.7% vs 6.8%, p < 0.001). Conclusions The COVID-19 outbreak affected the epidemiology of severe trauma patients. An increase in trauma patient admissions to a few designated facilities with high level of care obtained satisfactory results, while COVID-19 patients overwhelmed resources of most other hospitals.
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Affiliation(s)
- Riccardo Giudici
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Armando Lancioni
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Hedwige Gay
- Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Monza, Italy
| | - Gabriele Bassi
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy
| | - Osvaldo Chiara
- Emergency Department, General Surgery and Trauma Team, ASST Niguarda, University of Milano, Piazza Ospedale Maggiore 3, 20162, Milano, Italy.
| | - Claudio Mare
- Regional Agency of Emergency and Urgency, Milan, Italy
| | - Nicola Latronico
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.,Department of Anesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Brescia, Italy
| | - Antonio Pesenti
- Department of Anesthesia, Critical Care and Emergency, Fondazione Policlinico, University of Milan, Milan, Italy
| | | | - Luca Cabrini
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Roberto Fumagalli
- Department of Anesthesia and Intensive Care Medicine, ASST Niguarda, Milan, Italy.,Department of Anesthesia and Intensive Care Medicine, University Milano Bicocca, Milan, Italy
| | - Arturo Chieregato
- Department of Anesthesia and Intensive Care Medicine, Neuro Intensive Care, ASST Niguarda, Milan, Italy
| | - Laura Briani
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
| | - Fabrizio Sammartano
- Emergency Department, Emergency and Trauma Surgery, ASST Santi Carlo e Paolo, Milan, Italy
| | | | - Alberto Zoli
- Regional Agency of Emergency and Urgency, Milan, Italy
| | | | - Giuseppe Foti
- Department of Anesthesia and Intensive Care Medicine, S.Gerardo Hospital, University Milano Bicocca, Monza, Italy
| | - Erika Borotto
- Department of Anesthesia and Intensive Care, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | | | | | - Marco Botteri
- Regional Agency of Emergency and Urgency, Brescia, Italy
| | - Michele Carlucci
- General and Emergency Surgery and Emergency Department, Ospedale San Raffaele, Milan, Italy
| | - Elisa Reitano
- Department of Translational Medicine, University of Eastern Piedmont, Novara, Italy
| | - Roberto Bini
- Emergency Department, Department of General Surgery and Trauma Team, ASST Niguarda, Milan, Italy
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8
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Baldi E, Primi R, Gentile FR, Mare C, Centineo P, Palo A, Reali F, Rizzi U, Parogni P, Oltrona Visconti L, Savastano S. Out-of-hospital cardiac arrest incidence in the different phases of COVID-19 outbreak. Resuscitation 2020; 159:115-116. [PMID: 33385473 PMCID: PMC7771300 DOI: 10.1016/j.resuscitation.2020.12.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 10/29/2020] [Revised: 12/04/2020] [Accepted: 12/11/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy; Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Italy
| | | | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Azienda Regionale Emergenza Urgenza (AREU), Milan, Italy
| | - Paola Centineo
- AAT Varese, Azienda Regionale Emergenza Urgenza (AREU), Italy
| | - Alessandra Palo
- AAT Pavia, Azienda Regionale Emergenza Urgenza (AREU), Italy
| | | | - Ugo Rizzi
- AAT Cremona, Azienda Regionale Emergenza Urgenza (AREU), Italy
| | | | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
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9
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Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni PP, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S. Treatment of out-of-hospital cardiac arrest in the COVID-19 era: A 100 days experience from the Lombardy region. PLoS One 2020; 15:e0241028. [PMID: 33091034 PMCID: PMC7580972 DOI: 10.1371/journal.pone.0241028] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/08/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION An increase in the incidence of OHCA during the COVID-19 pandemic has been recently demonstrated. However, there are no data about how the COVID-19 epidemic influenced the treatment of OHCA victims. METHODS We performed an analysis of the Lombardia Cardiac Arrest Registry comparing all the OHCAs occurred in the Provinces of Lodi, Cremona, Pavia and Mantua (northern Italy) in the first 100 days of the epidemic with those occurred in the same period in 2019. RESULTS The OHCAs occurred were 694 in 2020 and 520 in 2019. Bystander cardiopulmonary resuscitation (CPR) rate was lower in 2020 (20% vs 31%, p<0.001), whilst the rate of bystander automated external defibrillator (AED) use was similar (2% vs 4%, p = 0.11). Resuscitation was attempted by EMS in 64.5% of patients in 2020 and in 72% in 2019, whereof 45% in 2020 and 64% in 2019 received ALS. At univariable analysis, the presence of suspected/confirmed COVID-19 was not a predictor of resuscitation attempt. Age, unwitnessed status, non-shockable presenting rhythm, absence of bystander CPR and EMS arrival time were independent predictors of ALS attempt. No difference regarding resuscitation duration, epinephrine and amiodarone administration, and mechanical compression device use were highlighted. The return of spontaneous circulation (ROSC) rate at hospital admission was lower in the general population in 2020 [11% vs 20%, p = 0.001], but was similar in patients with ALS initiated [19% vs 26%, p = 0.15]. Suspected/confirmed COVID-19 was not a predictor of ROSC at hospital admission. CONCLUSION Compared to 2019, during the 2020 COVID-19 outbreak we observed a lower attitude of laypeople to start CPR, while resuscitation attempts by BLS and ALS staff were not influenced by suspected/confirmed infection, even at univariable analysis.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
- Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Azienda Regionale Emergenza Urgenza, Milano, Italy
| | - Fabrizio Canevari
- SOREU della Pianura, Azienda Regionale Emergenza Urgenza (AREU), Pavia, Italy
| | | | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT Pavia—Azienda Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Contri
- AAT Pavia—Azienda Regionale Emergenza Urgenza (AREU) c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vincenza Ronchi
- AAT Pavia—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Pavia, Pavia, Italy
| | - Giorgio Beretta
- AAT Lodi—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Francesca Reali
- AAT Lodi—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Lodi, Lodi, Italy
| | - Pier Paolo Parogni
- AAT Mantova—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, Mantova, Italy
| | - Fabio Facchin
- AAT Mantova—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Mantova, Mantova, Italy
| | - Ugo Rizzi
- AAT Cremona—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Daniele Bussi
- AAT Cremona—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | - Simone Ruggeri
- AAT Cremona—Azienda Regionale Emergenza Urgenza (AREU) c/o ASST di Cremona, Cremona, Italy
| | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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10
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Fagoni N, Perone G, Villa GF, Celi S, Bera P, Sechi GM, Mare C, Zoli A, Botteri M. The Lombardy Emergency Medical System Faced with COVID-19: The Impact of Out-of-Hospital Outbreak. PREHOSP EMERG CARE 2020; 25:1-7. [PMID: 32940538 DOI: 10.1080/10903127.2020.1824051] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The Lombardy region was among the areas most affected by COVID-19 infection worldwide; the Lombardy Emergency Medical System (EMS) responded immediately to this emergency. We analyzed several critical aspects to understand what occurred in that region. METHODS This retrospective study compares the events managed by the dispatch center and the characteristics of the patients transported to the hospital -age, sex, SpO2, deaths- managed by the EMS in Brescia and Bergamo provinces between March-April 2020 and March-April 2019. Ambulances' waiting time at the hospitals before discharging patients and the patients' severity at emergency department admission were also analyzed. RESULTS EMS managed 37,340 events in March-April 2020, +51.5% versus 2019. "Breathing" or "Infective" events reported to the dispatch center increased more than ten-fold (OR 25.1, p < 0.0001) in March 2020 and two-fold in April 2020 compared to 2019 (OR 3, p < 0.0001). Deaths increased +246% (OR 1.7, p < 0.0001), and patients not transported to hospital +481% (OR 2.9, p < 0.0001) in March 2020 compared to 2019. In some hospitals, ambulances waited more than one hour before discharging the patients, and the emergency departments doubled the admission of critically ill patients. Transported patients for "Breathing" or "Infective" events were primarily males (OR 1.5, p < 0.0001). The patients had lower SpO2 in 2020 than in 2019 and they were younger. CONCLUSIONS The Lombardy region experienced an unexpected outbreak in an extremely short timeframe and in a limited area. The EMS coped with this pandemic, covering an extremely higher number of requests, with a ten-fold increase in the number of events managed.
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11
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Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S. COVID-19 kills at home: the close relationship between the epidemic and the increase of out-of-hospital cardiac arrests. Eur Heart J 2020; 41:3045-3054. [PMID: 32562486 PMCID: PMC7337787 DOI: 10.1093/eurheartj/ehaa508] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 01/08/2023] Open
Abstract
Aims An increase in out-of-hospital cardiac arrest (OHCA) incidence has been reported in the very early phase of the COVID-19 epidemic, but a clear demonstration of a correlation between the increased incidence of OHCA and COVID-19 is missing so far. We aimed to verify whether there is an association between the OHCA difference compared with 2019 and the COVID-19 epidemic curve. Methods and results We included all the consecutive OHCAs which occurred in the Provinces of Lodi, Cremona, Pavia, and Mantova in the 2 months following the first documented case of COVID-19 in the Lombardia Region and compared them with those which occurred in the same time frame in 2019. The cumulative incidence of COVID-19 from 21 February to 20 April 2020 in the study territory was 956 COVID-19/100 000 inhabitants and the cumulative incidence of OHCA was 21 cases/100 000 inhabitants, with a 52% increase as compared with 2019 (490 OHCAs in 2020 vs. 321 in 2019). A strong and statistically significant correlation was found between the difference in cumulative incidence of OHCA between 2020 and 2019 per 100 000 inhabitants and the COVID-19 cumulative incidence per 100 000 inhabitants both for the overall territory (ρ 0.87, P < 0.001) and for each province separately (Lodi: ρ 0.98, P < 0.001; Cremona: ρ 0.98, P < 0.001; Pavia: ρ 0.87, P < 0.001; Mantova: ρ 0.81, P < 0.001). Conclusion The increase in OHCAs in 2020 is significantly correlated to the COVID-19 pandemic and is coupled with a reduction in short-term outcome. Government and local health authorities should seriously consider our results when planning healthcare strategies to face the epidemic, especially considering the expected recurrent outbreaks.
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Affiliation(s)
- Enrico Baldi
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy.,Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Claudio Mare
- Azienda Regionale Emergenza Urgenza, Milan, Italy
| | - Fabrizio Canevari
- SOREU della Pianura, Azienda Regionale Emergenza Urgenza (AREU), Pavia, Italy
| | | | - Roberto Primi
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Clinical Epidemiology and Biometry, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Alessandra Palo
- AAT Pavia - Azienda Regionale Emergenza Urgenza (AREU), c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Enrico Contri
- AAT Pavia - Azienda Regionale Emergenza Urgenza (AREU), c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vincenza Ronchi
- AAT Pavia - Azienda Regionale Emergenza Urgenza (AREU), c/o Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.,ASST di Pavia, Pavia, Italy
| | - Giorgio Beretta
- AAT Lodi - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Lodi, Lodi, Italy
| | - Francesca Reali
- AAT Lodi - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Lodi, Lodi, Italy
| | - Pierpaolo Parogni
- AAT Mantova - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Mantua, Mantua, Italy
| | - Fabio Facchin
- Department of Molecular Medicine, Section of Cardiology, University of Pavia, Pavia, Italy
| | - Ugo Rizzi
- AAT Cremona - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Cremona, Cremona, Italy
| | - Daniele Bussi
- AAT Cremona - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Cremona, Cremona, Italy
| | - Simone Ruggeri
- AAT Mantova - Azienda Regionale Emergenza Urgenza (AREU), c/o ASST di Mantua, Mantua, Italy
| | | | - Simone Savastano
- Division of Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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12
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Perlini S, Canevari F, Cortesi S, Sgromo V, Brancaglione A, Contri E, Pettenazza P, Salinaro F, Speciale F, Sechi G, Mare C, Cutti S, Novelli V, Marena C, Muzzi A, Bruno R, Palo A. Emergency Department and Out-of-Hospital Emergency System (112-AREU 118) integrated response to Coronavirus Disease 2019 in a Northern Italy centre. Intern Emerg Med 2020; 15:825-833. [PMID: 32507926 PMCID: PMC7276336 DOI: 10.1007/s11739-020-02390-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
Since December 2019, the world has been facing the life-threatening disease, named Coronavirus disease-19 (COVID-19), recognized as a pandemic by the World Health Organization. The response of the Emergency Medicine network, integrating "out-of-hospital" and "hospital" activation, is crucial whenever the health system has to face a medical emergency, being caused by natural or human-derived disasters as well as by a rapidly spreading epidemic outbreak. We here report the Pavia Emergency Medicine network response to the COVID-19 outbreak. The "out-of-hospital" response was analysed in terms of calls, rescues and missions, whereas the "hospital" response was detailed as number of admitted patients and subsequent hospitalisation or discharge. The data in the first 5 weeks of the Covid-19 outbreak (February 21-March 26, 2020) were compared with a reference time window referring to the previous 5 weeks (January 17-February 20, 2020) and with the corresponding historical average data from the previous 5 years (February 21-March 26). Since February 21, 2020, a sudden and sustained increase in the calls to the AREU 112 system was noted (+ 440%). After 5 weeks, the number of calls and missions was still higher as compared to both the reference pre-Covid-19 period (+ 48% and + 10%, respectively) and the historical control (+ 53% and + 22%, respectively). Owing to the overflow from the neighbouring hospitals, which rapidly became overwhelmed and had to temporarily close patient access, the population served by the Pavia system more than doubled (from 547.251 to 1.135.977 inhabitants, + 108%). To minimize the possibility of intra-hospital spreading of the infection, a separate "Emergency Department-Infective Disease" was created, which evaluated 1241 patients with suspected infection (38% of total ED admissions). Out of these 1241 patients, 58.0% (n = 720) were admitted in general wards (n = 629) or intensive care unit (n = 91). To allow this massive number of admissions, the hospital reshaped many general ward Units, which became Covid-19 Units (up to 270 beds) and increased the intensive care unit beds from 32 to 60. In the setting of a long-standing continuing emergency like the present Covid-19 outbreak, the integration, interaction and team work of the "out-of-hospital" and "in-hospital" systems have a pivotal role. The present study reports how the rapid and coordinated reorganization of both might help in facing such a disaster. AREU-112 and the Emergency Department should be ready to finely tune their usual cooperation to respond to a sudden and overwhelming increase in the healthcare needs brought about by a pandemia like the current one. This lesson should shape and reinforce the future.
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Affiliation(s)
- Stefano Perlini
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy.
| | - Fabrizio Canevari
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Sergio Cortesi
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Vito Sgromo
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | | | - Enrico Contri
- SOREU Pianura, AREU (Azienda Regionale Emergenza Urgenza), Pavia, Italy
| | - Pietro Pettenazza
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesco Salinaro
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Francesco Speciale
- Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, IRCCS Policlinico San Matteo Foundation, Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Giuseppe Sechi
- AREU (Azienda Regionale Emergenza Urgenza), Milan, Italy
| | - Claudio Mare
- AREU (Azienda Regionale Emergenza Urgenza), Milan, Italy
| | - Sara Cutti
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Viola Novelli
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Carlo Marena
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Alba Muzzi
- Medical Direction, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
| | - Raffaele Bruno
- Infectious Disease Unit, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Alessandra Palo
- AAT 118 Pavia, AREU (Azienda Regionale Emergenza Urgenza), Department of Intensive Medicine, Policlinico San Matteo Foundation, Pavia, Italy
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Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Bua D, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med 2020; 383:496-498. [PMID: 32348640 PMCID: PMC7204428 DOI: 10.1056/nejmc2010418] [Citation(s) in RCA: 498] [Impact Index Per Article: 124.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
| | | | - Claudio Mare
- Azienda Regionale Emergenza Urgenza, Milan, Italy
| | | | | | - Roberto Primi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Enrico Contri
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Giorgio Beretta
- Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
| | - Francesca Reali
- Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
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14
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Baldi E, Sechi GM, Mare C, Canevari F, Brancaglione A, Primi R, Klersy C, Palo A, Contri E, Ronchi V, Beretta G, Reali F, Parogni P, Facchin F, Bua D, Rizzi U, Bussi D, Ruggeri S, Oltrona Visconti L, Savastano S. Out-of-Hospital Cardiac Arrest during the Covid-19 Outbreak in Italy. N Engl J Med 2020; 383:496-498. [PMID: 32348640 DOI: 10.1056/nejmc201041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
| | | | - Claudio Mare
- Azienda Regionale Emergenza Urgenza, Milan, Italy
| | | | | | - Roberto Primi
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Enrico Contri
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Giorgio Beretta
- Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
| | - Francesca Reali
- Azienda Socio Sanitaria Territoriale (ASST) di Lodi, Lodi, Italy
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15
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Limido A, Mare C, Giani S, Perlasca F, Bianchi M, Ghiringhelli S, Castiglioni B, Cattaneo P, Marchetti P, Bertelli Y, Zoli L, Pappa S, Guzzetti D, Salerno-Uriarte JA. [PROVA E TRASPORTA Project: results of tele-transmission of the electrocardiogram from community hospitals and emergency service ambulances in the management of ST-elevation acute coronary syndromes]. G Ital Cardiol (Rome) 2006; 7:498-504. [PMID: 16977789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
BACKGROUND Availability of a telematic system of electrocardiogram (ECG) transmission may improve the management of ST-elevation myocardial infarction (STEMI), by reducing time to treatment. The aim of this study was to show the effectiveness of telephone transmission of ECG in improving quality of care for patients with acute STEMI. METHODS Since January 1, 2003, we activated a management program of STEMI in healthcare district of Varese, located in the North-West of Lombardy (Italy), comprising one fourth-level hospital, equipped with a cath lab on call 24/24 h for primary angioplasty since 1993 and cardiac surgery, and 2 community hospitals, placed in a mountain area approximately 30 km far from Varese. The emergency medical system (EMS) transport was activated 24/24 h and has 15 basic life support (BLS) ambulances with trained nurse staff and 2 mobile units with medical staff, all of them equipped with semiautomatic defibrillator Lifepack 12, enabling a GSM telephone transmission of a 12-lead ECG, coupled with 3-lead continuous rhythm recording and clinical data, if necessary. The ECGs were transmitted to a core unit placed in the coronary care unit (CCU) of the Hospital di Circolo of Varese, directly connected with the EMS core unit. RESULTS From January 2003 to August 2005, a total of 2063 ECGs were transmitted, 538 of them (26%) recorded by EMS ambulances. Of 144 ECGs (7%) showing a persistent ST-elevation suggesting an acute STEMI (group A), 112 subjects underwent reperfusion: 73 were treated with angioplasty and 39 by lysis alone. By comparing data of group A with a group of 256 patients (180 reperfused) with acute STEMI, admitted to our hospital in the same period without ECG teletransmission (group B), we observed no statistical difference in mortality and reperfusion rates but a significative reduction in the pre-hospital and in-hospital times in group A patients treated by primary angioplasty and thrombolysis. CONCLUSIONS Our study confirms previous results in that an early availability of a 12-lead ECG, transmitted from peripheral community hospitals and BLS ambulances, is able to reduce time to management of patients with an acute STEMI, thus improving quality of decision-making and treatment.
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Affiliation(s)
- Alberto Limido
- U.O. di Cardiologia, Dipartimento di Scienze Cardiovascolari, Università degli Studi dell'Insubria. Ospedale di Circolo e Fondazione Macchi, Varese
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16
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Leşe M, Tămăşan A, Stoicescu B, Brânduşe M, Puia I, Mare C, Lazăr C. [Surgical treatment in severe acute pancreatitis. Last 15 years of experience in Emergency County Hospital of Baia Mare]. Chirurgia (Bucur) 2005; 100:445-50. [PMID: 16372670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
The aim of this study is to investigate the particular course of the patients operated for severe acute pancreatitis in a period of 15 years in surgical department of Emergency County Hospital of Baia Mare. Medical records of 202 patients admitted and operated for severe acute pancreatitis, were studied. Follow-up parameters were: age, gender, etiology, moment of operation, the type of operations and postoperative evolution of this patients. In the group of deceased patients alcoholic etiology of pancreatitis was prevailing. Almost a half of patients were operated in the first day of admission. A high number of patients were operated for diagnosis of acute abdomen with intention of exploratory laparotomy. In the last years, besides the usual closed drainage, open drainage and planning drainage were performed. Postoperative mortality is still high. The diagnose of severe acute pancreatitis is difficult in emergency. Global mortality in pancreatitis remains high, especially in the period of enzymatic shock, and is correlated with masculine gender, alcoholic etiology and somewhat with precocity of operation.
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Affiliation(s)
- Mihaela Leşe
- Secţia Chirurgie Generală, Spitalul Judeţean de Urgenţă Baia Mare.
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Severgnini P, Mare C, Aspesi M, Zocchi G, Mazzi G, Chiaranda M. [Observing an SSU Em 118 dispatch center for continuous quality improvement. The case of SSUEm 118 Varese]. Minerva Anestesiol 2000; 66:635-41. [PMID: 11070963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The present paper highlights quality aspects of the management of an Emergency Health Service Center (SSUEm 118, Varese) in order to identify the corrective measures required in a service that is increasingly close to the citizens real needs and expectations. Data were collected retrospectively on a total 54,301 calls for assistance in the period October 1997-March 1999 from an area covering some 1,300 sq.km with a population of 1,150,000 residents. That resident population was dramatically increased on a daily basis by heavy vehicle traffic particularly on the motorways to the area's many factories and to the Intercontinental Airport Malpensa 2000. The survey employed 7 anaesthetists and resuscitation staff, 14 nurses and 8 Italian Red Cross works from the Emergency Center. The researchers analysed the following phases: call reception and telephone conversation: ambulance dispatch, patient transportation and the alerting of the hospital of destination. The ServFMEA method was used for Quality Control with appropriate dispatch and the conduct and timing of the ambulance service in the Varese SSUEm 118 area. The data collected allowed for a detailed analysis of the accuracy of the information provided over the telephone (over-triage 58%, undertriage 2%), the usefulness of the telephone filter, the colour coding (correct in 40% of cases), pick-up times (5'40" on average) which were related to problems inherent in the ambulance call-out and the way ambulances reached the emergency (BLS 99%, ALS 1%, Air rescue < 1%). It was concluded that Varese SSUEm 118 was effectively and efficiently run in its first 18 months and results were improved as far as they could be given the inadequate funding of the Italian Heatlh Service.
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Affiliation(s)
- P Severgnini
- Unità Operativa di Anestesia e Rianimazione B, Università degli Studi, Insubria, Varese.
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