Prehospital advanced life support prior to hospitalization is associated with shorter door-to-antibiotic times for non-hypotensive individuals with sepsis upon arrival in the emergency department (ED), according to a study published in the Annals of the American Thoracic Society.

This retrospective cohort study included 361 patients with sepsis, in whom the acuteness of illness was positively associated with amount of prehospital care. Individuals treated with advanced life support before arrival at the hospital had shorter door-to-antibiotic times than those treated with basic life support (median, 103 min [IQR=75-135] vs 168 min [IQR=100-250]; P <.001) and those who did not receive care before arriving at the hospital (144 [IQR=98-251] min; P <.001). After adjustments, the same trend persisted: advanced life support led to shorter door-to-antibiotic times than basic life support care when compared with no care before arrival (–43 min [95% CI, –84 to –2 min]; P =.033 vs –4 min [95% CI, –41 to 34]; P =.97).

The administration of antibiotics took ≤3 hours for 91% of individuals treated with advanced life support, compared with 62% of walk-in patients (adjusted odds ratio [aOR], 3.11; 95% CI, 1.20-8.03; P =.015) and 56% of patients treated with basic life support (aOR, 4.51; 95% CI, 1.89-11.35; P <.001). Antibiotic treatment started sooner in individuals treated with advanced life support who did not have hypotension (–41 min; 95% CI, –110 to –13 min; P =.009) compared with those with hypotension (25 min; 95% CI, –43 to 92 min; P =.66).

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Individuals in this study were admitted to an academic ED between June 2009 and February 2015 for septic shock or fluid-refractory sepsis. The study only included patients whose antibiotic treatment began during hospitalization. The relationship between level of prehospital care and the amount of time between arrival and receipt of antibiotics was assessed with multivariable regression. The presence of hypotension at ED arrival was a variable in this relationship.

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The study researchers concluded that “[prehospital] care by [advanced life support] but not [basic life support] providers was associated with decreased door-to-antibiotic times for ED patients with sepsis who did not have hypotension present on ED arrival. Our findings suggest possible opportunities to optimize ED care processes to aid delivery of high-quality sepsis care in the ED.”


Peltan ID, Mitchell KH, Rudd KE, et al. Prehospital care and emergency department door-to-antibiotic time in sepsis [published online August 28, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201803-199OC