title: Post-resuscitation care at the emergency department with critical care facilities--a length-of-stay analysis.
abstract: OBJECTIVE
  An emergency department providing critical care will have an effect on outcome and intensive-care-units' resources by avoiding unnecessary or futile intensive-care admissions and thereby save hospital expenses. The study focussed on this result.
  
  
  METHODS
  The study employed a retrospective analysis of prospectively collected data of out-of-hospital cardiac arrest patients with return of spontaneous circulation, comatose on arrival. Outcomes and length of stay of patients who either stayed at the 'emergency department only' or were 'transferred in addition to an intensive care unit' were compared. Linear regression with log length of stay as outcome and 'emergency department only' as predictor with covariates was used for modelling.
  
  
  RESULTS
  From 1991 to 2008, out of 1236 patients (age 57 ± 15 years, female 31%), the 'emergency department only' group (n=349 (28%)) survived to discharge in 81(23%) cases, with a median length-of-stay in critical care of 1.7 (interquartile range 0.8; 3.1) days. The patients 'transferred in addition to an intensive care unit' (n=887 (72%)), with a survival rate of 55% (n=486, p<0.001) stayed 10 (5; 18) days (p<0.001). The length-of-stay in hospital was significantly shorter if patients were treated in the 'emergency department only' independent of other cardiac-arrest-related factors (regression coefficient -1.42, confidence interval -1.60 to -1.24).
  
  
  CONCLUSIONS
  An emergency department with critical care prevents admissions to intensive care units in 28% of patients with out-of-hospital cardiac arrest. It saves intensive-care-unit resources and shortens length of stay for comatose out-of-hospital cardiac-arrest survivors, regardless of their outcome.
authors.affiliation: Department of Emergency Medicine, Medical University of Vienna, Vienna, Austria.
authors.forename: Andreas
authors.initials: A
authors.lastname: Schober
authors.forename: Fritz
authors.initials: F
authors.lastname: Sterz
authors.forename: Harald
authors.initials: H
authors.lastname: Herkner
authors.forename: Gottfried J
authors.initials: GJ
authors.lastname: Locker
authors.forename: Gottfried
authors.initials: G
authors.lastname: Heinz
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuhrmann
authors.forename: Christian
authors.initials: C
authors.lastname: Sitzwohl
authors.forename: Christoph
authors.initials: C
authors.lastname: Weiser
authors.forename: Christian
authors.initials: C
authors.lastname: Wallmüller
authors.forename: Peter
authors.initials: P
authors.lastname: Stratil
authors.forename: Mathias
authors.initials: M
authors.lastname: Stöckl
authors.forename: Michael
authors.initials: M
authors.lastname: Holzer
authors.forename: Heidrun
authors.initials: H
authors.lastname: Losert
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
mesh_terms: D001317:Austria / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation; D003422:Critical Care / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors