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Clinical Trials

Impact of critical care outreach on hematopoietic stem cell transplant recipients: a cohort study

Bone Marrow Transplantation volume 46, pages 1138–1144 (2011)Cite this article

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Abstract

Serious morbidity and mortality can occur after hematopoietic SCT (HSCT). Critical care outreach (CCO) can provide timely access to intensive care for hospitalized patients in need of urgent stabilization but has not been examined in HSCT. Rapid Assessment of Critical Events (RACE) team was introduced at our centre January 1, 2005. A retrospective cohort study was performed. Patients undergoing HSCT between January 1, 2000 and December 31, 2004 (n=520) formed the ‘before’ cohort and patients transplanted between January 1, 2005 and December 31, 2007 (n=294) formed the ‘after’ cohort. Non-relapse mortality at day 100 after transplant was not different in the two cohorts (26 (8.8%) post-RACE vs 53 (10.2%) pre-RACE, P=0.62). The number of failed organs at time of transfer to intensive care unit (ICU) was reduced in the post-RACE cohort (1.9±0.8 vs 2.3±1.0, P=0.04) and the incidence of cardiovascular failure was lower (23.8 vs 43.8%, P=0.04). Other secondary outcomes were not different, including the frequency of ICU admission. RACE may contribute to earlier stabilization during critical illness in patients undergoing HSCT but does not reduce non-relapse mortality. CCO should be studied prospectively in patients undergoing HSCT to better evaluate its role.

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Acknowledgements

We thank Dr Lothar Huebsch and Sheryl McDiarmid for assistance with the database. This study was supported by funds from the Ministry of Health and Long-term Care in Ontario and The Ottawa Hospital (RACE team); The Ottawa Hospital Foundation Bone Marrow Transplant Research Fund for a summer studentship (AC) and to support the clinical BMT database at The Ottawa Hospital Blood and Marrow Transplant Program. DA is an adjunct scientist with Canadian Blood Services, Ottawa (Canada) and holds a New Investigator Award from the Canadian Institutes for Health Research and a Research Award from the Department of Medicine, University of Ottawa.

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Authors and Affiliations

  1. Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,

    O Hayani & D S Allan

  2. Department of Critical Care, University of Ottawa, Ottawa, Ontario, Canada

    O Hayani, A Kharaba, A Baxter & R Patel

  3. Blood and Marrow Transplant Program, The Ottawa Hospital, Ottawa, Ontario, Canada

    A Al-Beihany, A Chou & D S Allan

  4. Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada

    R Zarychanski & R Patel

  5. Department of Hematology and Medical Oncology, CancerCare Manitoba, Winnipeg, Manitoba, Canada

    R Zarychanski

  6. Department of Internal Medicine, Sections of Hematology and Critical Care, University of Manitoba, Winnipeg, Manitoba, Canada

    R Zarychanski

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  1. O Hayani
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Correspondence to D S Allan.

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Hayani, O., Al-Beihany, A., Zarychanski, R. et al. Impact of critical care outreach on hematopoietic stem cell transplant recipients: a cohort study. Bone Marrow Transplant 46, 1138–1144 (2011). https://doi.org/10.1038/bmt.2010.248

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