Post-resuscitation care at the emergency department with critical care facilities--a length-of-stay analysis

Aim of the study

An emergency department providing critical care will have an effect on outcome and intensive-care-units’ resources by avoiding unnecessary or futile intensive-care admissions and thereby save hospital expenses. The study focussed on this result.

Methods

The study employed a retrospective analysis of prospectively collected data of out-of-hospital cardiac arrest patients with return of spontaneous circulation, comatose on arrival. Outcomes and length of stay of patients who either stayed at the ‘emergency department only’ or were ‘transferred in addition to an intensive care unit’ were compared. Linear regression with log length of stay as outcome and ‘emergency department only’ as predictor with covariates was used for modelling.

Results

From 1991 to 2008, out of 1236 patients (age 57 ± 15 years, female 31%), the ‘emergency department only’ group (n = 349 (28%)) survived to discharge in 81(23%) cases, with a median length-of-stay in critical care of 1.7 (interquartile range 0.8; 3.1) days. The patients ‘transferred in addition to an intensive care unit’ (n = 887 (72%)), with a survival rate of 55% (n = 486, p < 0.001) stayed 10 (5; 18) days (p < 0.001). The length-of-stay in hospital was significantly shorter if patients were treated in the ‘emergency department only’ independent of other cardiac-arrest-related factors (regression coefficient −1.42, confidence interval −1.60 to −1.24).

Conclusions

An emergency department with critical care prevents admissions to intensive care units in 28% of patients with out-of-hospital cardiac arrest. It saves intensive-care-unit resources and shortens length of stay for comatose out-of-hospital cardiac-arrest survivors, regardless of their outcome.