Abstract
BackgroundAcute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting. Although an association between prehospital arterial hypercapnia in AHF patients and admission in high-dependency and intensive care units has been previously described, there is little data to support an association between prehospital arterial hypercapnia and mortality in this population.MethodsThis was a retrospective study based on electronically recorded prehospital medical files. All adult patients with AHF were included. Records lacking arterial blood gas data were excluded. Other exclusion criteria included the presence of a potentially confounding diagnosis, prehospital cardiac arrest, and inter-hospital transfers. Hypercapnia was defined as a PaCO2 higher than 6.0 kPa. The primary outcome was in-hospital mortality, and secondary outcomes were 7-day mortality and emergency room length of stay (ER LOS). Univariable and multivariable logistic regression models were used.ResultsWe included 225 patients in the analysis. Prehospital hypercapnia was found in 132 (58.7%) patients. In-hospital mortality was higher in patients with hypercapnia (17.4% [23/132] versus 6.5% [6/93], p = 0.016), with a crude odds-ratio of 3.06 (95%CI 1.19–7.85). After adjustment for pre-specified covariates, the adjusted OR was 3.18 (95%CI 1.22–8.26). The overall 7-day mortality was also higher in hypercapnic patients (13.6% versus 5.5%, p = 0.044), and ER LOS was shorter in this population (5.6 h versus 7.1 h, p = 0.018).ConclusionPrehospital hypercapnia is associated with an increase in in-hospital and 7-day mortality in patient with AHF.
Highlights
Acute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting
The rationale for no arterial blood gas (ABG) being performed was unknown in most cases (291/448, 65%)
Documented reasons for absence of ABG were a failed attempt by physician or collection of a venous sample (78), technical failure of the analyzer (31), medical decision (45), and patient refusal [3]
Summary
Acute Heart Failure (AHF) is a potentially lethal pathology and is often encountered in the prehospital setting. An association between prehospital arterial hypercapnia in AHF patients and admission in highdependency and intensive care units has been previously described, there is little data to support an association between prehospital arterial hypercapnia and mortality in this population. Acute Heart Failure (AHF) is a common and lifethreatening medical condition which requires urgent evaluation and management and is associated with a high burden of morbidity and mortality [1, 2]. In Switzerland, AHF led to the death or to the readmission of 8120 patients in 2005 [3]. NIV has been shown to reduce intubation rate in AHF [14]. It seems to alleviate symptoms in the emergency room (ER) [15]
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