Survival of severely shocked patients who present with absent radial pulse and unrecordable blood pressure in the pre-hospital phase

SummaryObjectivesTo determine the mortality and clinical features of patients presenting with severe hypotension in the pre-hospital phase of care.DesignA prospective observational study. The medical records of patients attended by a physician-led pre-hospital medical service were examined prospectively. Inclusion criteria were severe shock characterized by a non-palpable radial pulse and unrecordable blood pressure at clinical presentation. All consecutive records between September 2002 and September 2003 were included.SettingSeine Saint-Denis, an urban area with a population of 1.5 million located in the northern suburbs of Paris, France.InterventionsNone.ResultsOne hundred and thirty one patients met the inclusion criteria. The overall mortality was 50% (66/131). Of the deaths, 20% (13/66) occurred in the pre-hospital phase and 80% (53/66) after arrival in hospital. Clinical features significantly associated with increased mortality were: more than one pre-existing co-morbidity, increased age, high Knaus score, a low Glasgow Coma Score, vasopressor administration, pre-hospital cardiac arrest and hypotension on arrival at hospital. The presence of anaphylactic shock was associated with low mortality. In multivariate analysis, occurrence of cardiac arrest (OR = 13.5 [2.8; 64.5]), age (OR = 1.03 [1.01; 1.05]) and low Glasgow Coma Scale score value (OR = 1.15 [1.05; 1.29]) were independently associated with mortality.ConclusionPatients presenting with profound hypotension in the pre-hospital phase have a high mortality. Patients who recover their blood pressure with interventions before hospital admission and those with anaphylactic shock have a better outcome than other patient sub-groups.