(1304) Critical Care Resuscitation Unit and Management of Intrahospital Upgraded Patients

Introduction: The Critical Care Resuscitation Unit (CCRU) at the University of Maryland Medical Center (UMMC), is an intensive care unit (ICU)-based resuscitation unit and was designed to transfer critically ill patients from other hospitals. A notable patient population consists of upgrades within the UMMC, if there is no available ICU bed or if they require Extracorporeal Membrane Oxygenation (ECMO). We hypothesized that CCRU's resuscitation of these clinically deteriorated patients would correlate with their in-hospital outcome.

Methods: A retrospective analysis of patients upgraded from within UMMC to the CCRU from 1/1/2019-5/1/2020 was performed. Multivariate ordinal logistic and univariable probit logit regressions were used to determine clinical variables’ association with hospital dispositions (ranking from discharge home directly, acute rehab, skilled nursing facility or dead/hospice).

Results: We analyzed 126 patients’ charts, mean (+/- SD) of SOFA at upgrade was 8 (4), at leaving the CCRU was 7 (5), SOFA reduction during CCRU stay was -0.6 (4), respectively. Mean age of patients was 61 (20), and 89 (71%) of these patients were upgraded from a general ward unit, 14 (11%) from an operating room, 23 (18%) from another ICU. While in the CCRU, 19 (15%) of patients from our other ICUs were initiated on ECMO, 57 (45%) were initiated on vasopressors and 70 (56%) were initiated on mechanical ventilation. Patients’ final dispositions included home (24%), acute rehab (27%), skilled nursing home (23%), death/hospice (26%). High SOFA score at upgrade (Coefficient -0.16, OR 0.86, 95%CI 0.78-0.94), small SOFA reduction (Coefficient -0.11, OR 0.89, 95%CI 0.80-0.99, p = 0.039) was associated with higher odds of dead/hospice. Probit logit regression showed that patients with SOFA score of 14 at CCRU upgraded would be associated with 50% probability of hospital mortality.

Conclusions: The CCRU provides a wide range of resuscitation for clinically deteriorated patients from within our hospital, and with a small overall reduction of these patients’ physiologic derangements. The reduction of SOFA score during CCRU stay was associated with patients’ lower odds of in-hospital outcome. Further studies, particularly comparing between these upgrade patients and those being transferred from other hospitals, are needed.