title: Survival of severely shocked patients who present with absent radial pulse and unrecordable blood pressure in the pre-hospital phase.
abstract: OBJECTIVE
  To determine the mortality and clinical features of patients presenting with severe hypotension in the pre-hospital phase of care.
  
  
  METHODS
  A 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.
  
  
  METHODS
  Seine Saint-Denis, an urban area with a population of 1.5 million located in the northern suburbs of Paris, France.
  
  
  METHODS
  None.
  
  
  RESULTS
  One 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.
  
  
  CONCLUSIONS
  Patients 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.
authors.affiliation: SAMU 93, EA 3409 Hopital Avicenne, Université Paris 13, 93009 Bobigny Cedex, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Poloujadoff
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.forename: David
authors.initials: D
authors.lastname: Lockey
authors.forename: Roland
authors.initials: R
authors.lastname: Amathieu
authors.forename: Mehdi
authors.initials: M
authors.lastname: Merouani
authors.forename: Michel
authors.initials: M
authors.lastname: Galinski
authors.forename: Frédéric
authors.initials: F
authors.lastname: Adnet
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000707:Anaphylaxis / Q000150:complications / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D015600:Glasgow Coma Scale; D006323:Heart Arrest / Q000150:complications / Q000401:mortality; D006801:Humans; D007022:Hypotension / Q000401:mortality*; D007223:Infant; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011446:Prospective Studies; D012769:Shock / Q000209:etiology / Q000401:mortality*