Taylor Miller, MD
Resident
University of Maryland Medical System
Baltimore, MD
Disclosure information not submitted.
Maie Abdel Wahab, n/a
Student
University of Maryland Research Associate Program, United States
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Ikram Afridi, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Leenah Afridi, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Richa Beher, BS
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Vera Bzhilyanskaya, BS
Student
University of Maryland Research Associate Program
College Park, Maryland, United States
Disclosure information not submitted.
.jpg "Nikki Emamian (she/her/hers) photo")
Hannah Frederick, BS
Student
University of Maryland Research Associate Program, United States
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Grace Hollis, n/a
Student
University of Maryland Research Associate Program, United States
Disclosure information not submitted.
Isha Yardi, n/a
Student
University of Maryland Research Associate Program, United States
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Emilie Berman, BS
Student
University of Maryland, College Park
College Park, Maryland, United States
Disclosure information not submitted.
Tiffany Cao, BS
University of Maryland School of Medicine
Baltimore, MD
Disclosure information not submitted.
Nelson Chen, BS
Student
University of Maryland School of Medicine, United States
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Allison Karwoski, BS
Student
University of Maryland School of Medicine, United States
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Adelina Buganu, MD
Resident
8Department of Emergency Medicine, Mercer University at Coliseum Medical Center, Macon, Georgia, USA, United States
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Stephanie Cardona, DO
Physician
University of Maryland, United States
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Zoe Glick, MD
Resident
University of Maryland, Maryland, United States
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Daniel Haase, MD, (he/him/his)
Associate Professor of Emergency Medicine and Surgery
R. Adams Cowley Shock Trauma Center
Baltimore, MD
Disclosure information not submitted.
William Teeter, MD
Physician
University of Maryland School of Medicine, United States
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Quincy Tran, MD, PhD, FCCM
Associate Professor
University of Maryland Medical Center
Baltimore, MD, United States
Disclosure information not submitted.
Title: Association between Resuscitation in the Critical Care Resuscitation Unit and In-hospital Mortality
Introduction:
The Critical Care Resuscitation Unit (CCRU) expedites transfer and early resuscitation of critically ill patients from outside hospitals to the University of Maryland Medical Center (UMMC). Patients who present in severe shock (defined as serum lactate ≥ 4 millimole per liter [mmol/L]) have high expected mortality and early resuscitation is crucial to improve their outcomes. We hypothesized that lactate clearance and improvement in Sequential Organ Failure Assessment (SOFA) score during CCRU stay would be associated with lower in-hospital mortality.
Methods:
We performed a retrospective analysis of adult patients who were admitted to the CCRU between 01/01/2018 -12/31/2018 and had serum lactate ≥ 4mmol/L. We used multivariable logistic regression to evaluate the association between lactate clearance and improvement in SOFA scores during CCRU stay and in-hospital mortality while controlling for age, mechanical ventilatory status, and vasopressor status.
Results:
A total of 1,741 patients were admitted to the CCRU in 2018, of whom 172 (10%) had serum lactate ≥ 4mmol/L. Twenty-two (13%) patients died during their CCRU stay and were excluded from the analysis. Our primary analysis included a total of 130 patients with lactate clearance data and 137 patients with SOFA data. Average patients’ age was 54 (16) years, and median length of stay in the CCRU was 6 hours and 55 minutes. The average lactate and SOFA score on admission were 7.4 (3.8) mmol/L and 8.3 (4.7), respectively. Average lactate clearance was 1.9 (3.1) and average SOFA score improvement was 0.2 (2.9). Each point of lactate clearance during the CCRU stay was associated with 2.9% reduced odds of in-hospital mortality (OR 0.971, 95% CI 0.945-0.997, p = 0.029) and each point of SOFA score improvement was associated with 3.5% reduced odds of in-hospital mortality (OR 0.965, 95% CI 0.938-0.992, p = 0.01).
Conclusions:
Care in the CCRU is effective at reducing lactate, but less effective at improving SOFA scores in patients with severe shock. Both lactate clearance and SOFA score improvement in the resuscitation phase were associated with decreased odds of in-hospital mortality in this group of patients. Further studies are necessary to confirm our observations.