Prehospital critical care drug-therapy and 30-day mortality in patients with acute respiratory disease

doi:10.5847/wjem.j.1920-8642.2025.008

Abstract

Abstract:

BACKGROUND Prehospital medication is a reality, and the role of these therapies must be explored to assess their validity, especially for acute respiratory diseases, which are usually associated with increased morbidity. The aim of this study was to examine the association of prehospital medication use with mortality in patients with acute respiratory disease.

METHODS: A prospective, multicenter, emergency medical service (EMS) delivery cohort study was carried out in adults with unselected respiratory diseases managed by EMS who were transferred to the emergency department. From January 1, 2019, to October 31, 2023, six advanced life support units, thirty-eight basic life support units, and four hospitals in Spain participated in the study. Demographic data, vital signs, use of mechanical ventilation, prehospital respiratory diagnosis, and prehospital medication were collected. The primary outcome was 30-day in-hospital mortality.

RESULTS: A total of 961 patients were included, with a mortality rate of 17.5% (168 patients). Age, an increasing number of comorbidities, the use of invasive mechanical ventilation (IMV), the use of major analgesics, hypnotics, and bicarbonate were risk factors. In contrast, elevated systolic blood pressure and Glasgow Coma Scale scores were found to be protective factors against mortality. The predictive capacity of the model reached an area under the curve (AUC) of 0.857 (95% confidence interval [95% CI] 0.827-0.888).

CONCLUSION: Our data revealed that IMV, major analgesics, hypnotics and bicarbonate administration were associated with elevated mortality. Adding prehospital drug therapy information to demographic variables and vital signs could improve EMS decision-making, allowing a better characterization of patients at risk of clinical worsening.

Key words: Drug-therapy, Medication, Prehospital, Mortality, Emergency medical services

Jesús Jurado-Palomo, José Luis Martín-Conty, Begoña Polonio-López, Cristina Rivera Picón, Raúl López-Izquierdo, Carlos del Pozo Vegas, Pedro Ángel de Santos Castro, Ancor Sanz-García, Francisco Martín-Rodríguez. Prehospital critical care drug-therapy and 30-day mortality in patients with acute respiratory disease[J]. World Journal of Emergency Medicine, 2025, 16(1): 43-50.

Figures/Tables 6

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Parameters^a	Survivors (n=793)	Non-survivors (n=168)	P-value^b
Epidemiological variables
Sex at birth, female	327 (41.2)	68 (40.5)	0.924
Age, year	71.2±16.0	75.6±13.5	<0.001
Ambulance, advanced life support	437 (55.1)	124 (73.8)	<0.001
Nursing home, yes	139 (17.5)	48 (28.6)	0.001
Basal vital signs
Respiratory rate, breaths/min	26.5±9.0	28.5±11.0	0.026
Oxygen saturation, %	88.3±11.0	81.4±14.2	<0.001
Fraction of inspired oxygen, %	0.4±0.2	0.6±0.3	<0.001
SaO₂/FiO₂ ratio	378±97	330±111	<0.001
Systolic blood pressure, mmHg	139±32	125±39	<0.001
Diastolic blood pressure, mmHg	79±20	72±24	<0.001
Heart rate, beats/min	98.1±25.5	104.0±32.8	0.044
Temperature, °C	36.6±1.0	36.6±1.4	0.751
Glasgow Coma Scale, points	14.1±2.5	11.4±4.5	<0.001
Prehospital respiratory diagnosis			<0.001
Dyspnea	312 (39.3)	71 (42.3)
COPD	128 (16.1)	17 (10.1)
Respiratory infection	173 (21.8)	55 (32.7)
COVID-19	108 (13.6)	13 (7.7)
Asthma crisis	32 (4.0)	0 (0.0)
Others^c	40 (5.0)	12 (7.1)
Outcomes
Prehospital NIMV	133 (16.8)	56 (33.3)	<0.001
Prehospital IMV	47 (5.9)	50 (29.8)	<0.001
aCCI, points	6.1±3.3	7.5±3.3	<0.001
Inpatient	567 (71.6)	168 (100.0)	<0.001
ICU-admission	74 (9.3)	52 (31.0)	<0.001

Medications	Survivors (n=793)	Non-survivors (n=168)	P-value^a
Anti-convulsant	6 (0.8)	1 (0.6)	0.998
Antiarrhythmic	10 (1.3)	4 (2.4)	0.284
Antibiotic	2 (0.3)	0 (0.0)	0.989
Antidote	10 (1.3)	7 (4.2)	0.018
Antiemetic	41 (5.2)	14 (8.3)	0.155
Antihypertensive	16 (2.0)	2 (1.2)	0.754
Antiplatelet agent	3 (0.4)	3 (1.8)	0.070
Anxiolytic	82 (10.4)	46 (27.4)	<0.001
Atropine	2 (0.3)	5 (3.0)	0.002
Beta-2-agonist (inhaled)	424 (53.5)	85 (50.6)	0.553
Beta-blocker	7 (0.9)	3 (1.8)	0.392
Bicarbonate	6 (0.8)	16 (9.5)	<0.001
Diuretic	183 (23.1)	34 (20.2)	0.485
Epinephrine	10 (1.3)	10 (6.0)	0.001
Fibrinolytic	0 (0.0)	3 (1.8)	0.005
Glucocorticoid	418 (52.7)	88 (52.4)	0.997
Glucocorticoid (inhaled)	231 (29.1)	44 (26.2)	0.502
Glucose 50%	6 (0.8)	5 (3.0)	0.029
Heparin	10 (1.3)	7 (4.2)	0.018
Hypnotics	40 (5.0)	47 (28.0)	<0.001
Insulin	31 (3.9)	11 (6.6)	0.190
Ions	14 (1.8)	5 (3.0)	0.354
Ipratropium bromide (inhaled)	403 (50.8)	70 (41.6)	0.031
Major analgesics	159 (20.1)	83 (49.4)	<0.001
Minor analgesics	206 (26.2)	51 (30.4)	0.311
Neuromuscular blocking agent	23 (2.9)	23 (13.7)	<0.001
Nitro-glycerine	67 (8.5)	11 (6.6)	0.507
Norepinephrine	11 (1.3)	17 (10.1)	<0.001
Proton pump inhibitor	60 (7.6)	11 (6.6)	0.767
Tranexamic acid	3 (0.4)	1 (0.6)	0.537

Variables	Odds ratio (95% CI)	P-value
Age	1.03 (1.02-1.05)	<0.001
Systolic blood pressure	0.99 (0.98-0.99)	0.009
Glasgow Coma Scale	0.86 (0.82-0.90)	<0.001
Age-Charlson comorbidity index	1.08 (1.02-1.14)	0.017
Invasive mechanical ventilation	7.21 (3.97-13.1)	<0.001
Non-invasive mechanical ventilation	2.46 (1.66-3.63)	<0.001
Major analgesics	2.26 (1.56-3.27)	<0.001
Hypnotics	4.64 (2.44-8.98)	<0.001
Neuromuscular blocking agent	0.17 (0.06-0.45)	0.003
Bicarbonate	5.23 (1.96-15.5)	0.007

Variables	Odds ratio (95% CI)	P-value
Age	1.03 (1.02-1.06)	<0.001
Systolic blood pressure	0.99 (0.98-1.00)	0.004
Glasgow Coma Scale	0.81 (0.76-0.88)	<0.001
aCCI	1.09 (1.01-1.18)	0.026
Non-invasive mechanical ventilation	2.32 (1.39-3.90)	0.001
Major analgesics	2.06 (1.22-3.47)	0.007
Hypnotics	7.45 (2.90-20.76)	<0.001

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