Abstract
IntroductionPatients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. At our academic referral center, the neurocritical care unit (NCCU) receives patients directly from referring facilities. However, when no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). We hypothesized that the CCRU expedites transfer of sICH patients and facilitates timely external ventricular drain (EVD) placement comparable to the NCCU.MethodsThis is a pre-post study of adult patients transferred with sICH and EVD placement. Patients admitted between January 2011–July 2013 (2011 Control) were compared with patients admitted either to the CCRU or the NCCU (2013 Control) between August 2013–September 2015. The primary outcome was time interval from arrival at any intensive care units (ICU) to time of EVD placement (ARR-EVD). Secondary outcomes included time interval from emergency department transfer request to arrival, and in-hospital mortality. We assessed clinical association by multivariable logistic regressions.ResultsWe analyzed 259 sICH patients who received EVDs: 123 (48%) CCRU; 81 (31%) 2011 Control; and 55 (21%) in the 2013 Control. The groups had similar characteristics, age, disease severity, and mortality. Median ARR-EVD time was 170 minutes [106–311] for CCRU patients; 241 minutes [152–490] (p < 0.01) for 2011 Control; and 210 minutes [139–574], p = 0.28) for 2013 Control. Median transfer request-arrival time for CCRU patients was significantly less than both control groups. Multivariable logistic regression showed each minute delay in ARR-EVD was associated with 0.03% increased likelihood of death (odds ratio 1.0003, 95% confidence interval, 1.0001–1.006, p = 0.043).ConclusionPatients admitted to the CCRU had shorter transfer times when compared to patients admitted directly to other ICUs. Compared to the specialty NCCU, the CCRU had similar time interval from arrival to EVD placement. A resuscitation unit like the CCRU can complement the specialty unit NCCU in caring for patients with sICH who require EVDs.
Highlights
Patients with spontaneous intracranial hemorrhage are associated with high mortality and require early neurosurgical interventions
We identified 343 patients who were transferred from other hospitals to our institution and received external ventricular drain (EVD) placement between January 2011–September 2015
We demonstrated that the Critical Care Resuscitation Unit can complement the specialty Neurocritical Care Unit in the care of patients with spontaneous intracranial hemorrhage (sICH) and who required EVD placement in the hyperacute and acute phase
Summary
Patients with spontaneous intracranial hemorrhage (sICH) are associated with high mortality and require early neurosurgical interventions. When no NCCU bed is immediately available, patients are initially admitted to the critical care resuscitation unit (CCRU). External ventricular drain (EVD) placement in these patients has been associated with improved mortality and functional outcomes.. The CCRU is a six-bed ICU-based resuscitation unit that is staffed by a 24/7 team of intensivists and advanced practice providers (APP). It focuses on rapid transfer of critically ill patients or patients with time-sensitive diseases for initial resuscitation and evaluation before transferring them to a specialized ICU.. For patients with sICH, when there are no available beds at the NCCU, the CCRU admits, provides initial resuscitation, manages blood pressure, and supports for EVD placement as indicated. Patients are subsequently transferred to an available bed at the NCCU for further longitudinal care
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