Critical care resuscitation units offer better outcomes than ICUs for critically ill patients

por John R. Fischer, Senior Reporter | January 16, 2020
Emergency Medicine
CCRUs lower risk of death by 36 percent compared to ICUs.
A patient with an acutely life-threatening health condition may fare better in a critical care resuscitation unit (CCRU) than a traditional intensive care unit, according to a new study.

Researchers at the University of Maryland School of Medicine found CCRU patients received faster treatment and had better health outcomes, including a 36 percent lower risk of death, than those transferred from the emergency department to the ICU.

"We have provided an important validation of the CCRU model, showing that it significantly improves patient outcomes," said Dr. Quincy Tran, assistant professor of emergency medicine at UMSOM who led the study. "Now that we have the data on the lifesaving potential of the CCRU, we hope to see other hospitals creating similar models."

Critically ill patients who experience sudden life-threatening conditions often end up in the ED of the hospital nearest to them and are then transferred to a larger institution with an ICU or trauma center if the condition requires a greater level of care that the local hospital cannot provide. Evaluating and transferring patients from EDs is often ad hoc and fragmented, and delays patients from receiving time-sensitive care that could save their life or prevent permanent disability.

The team analyzed the records of 1,565 critically ill patients, 644 of which were treated in the CCRU established by The University of Maryland R. Adams Cowley Shock Trauma Center and the Program in Trauma at UMSOM in 2013. It is the first resuscitation unit established in the U.S. The other individuals were transferred directly from other hospitals’ EDs to traditional intensive care units at UMMC in 2012 before the CCRU opened and in 2013 after it opened. The latter ones served as the control group in the study.

Average time for accessing the CCRU after a transfer request was filed was 108 minutes, compared to 158 minutes for those transferred and treated in 2012 in the ICU and 185 minutes for those in 2013. CCRU patients in need of emergency surgery received care about 3.5 hours on average after their arrival, while those in the control group waited six to seven hours. Procedures performed in the CCRU included massive blood transfusions, continuous renal replacement therapy (dialysis) for patients with malfunctioning kidneys, continuous EEG monitoring of the brain, and organ support with a heart-lung machine.

Taking into account variations in the severity of disease and care, researchers found that CCRU patients were 36 percent more likely to survive than those in the control group. The study is the first to show that utilization of the CCRU doubles the number of transferred patients from other hospitals’ EDs and leads to faster access to critical care resources and definitive surgical treatment, which decreases a patient’s risk of dying from their illness.

"Having the data to demonstrate improved patient outcomes will hopefully convince other hospitals to consider adopting this model of care," said UMSOM Dean Dr. E. Albert Reece, university executive vice president for medical affairs and the John Z. and Akiko K. Bowers Distinguished Professor, in a statement.

The findings were published in the Journal of Emergency Medicine.

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