Abstract 18330: Direct Transport to a PCI Center Following Out-of-Hospital Cardiac Arrest is Associated With Improved Survival in North Carolina

Abstract

Introduction: Guidelines recommend implementation of regional systems of care for out-of-hospital cardiac arrest (OHCA) patients. Whether direct transport of OHCA patients to a PCI center over a non-PCI center improves outcomes is unknown. Hypothesis: Direct transport to a PCI center is associated with better outcomes. Methods: Using the Cardiac Arrest Registry to Enhance Survival, we identified OHCA patients with pre-hospital return of spontaneous circulation (ROSC) from 16 counties (population 3,143,809) in North Carolina between 2012-2014. Destination hospital was classified by PCI center status. We performed logistic regression analyses using propensity score inverse probability weights including drive time to nearest PCI center, initial rhythm and prehospital ECG information. Results: Of 1508 patients with ROSC, 1360 (90.2%) were transported to a PCI center and 148 (9.8%) to a non-PCI center (Table). The unadjusted survival rate was higher among those directly transported to a PCI center (33.5% versus 14.6%), OR 2.95 (95% CI 1.84-4.76). After accounting for potential confounding using inverse probability weights as well as adjusting for age, sex, EMS response time and clustering of county, direct transport to PCI center remained significantly associated with better survival, OR 2.47 (95% CI 2.08-2.92). Significant differences in survival remained when including patients without ST-elevation myocardial infarction only, adjusted OR 1.74 (95% CI 1.05-2.91). For patients bypassing the nearest hospital and taken directly to a PCI center with >10 min of difference in drive time between nearest hospital and PCI center, adjusted OR was 2.54 (95% CI 2.01-3.23) compared to patients taken to non-PCI hospitals. Conclusions: Direct transport to a PCI center appears to be associated with improved survival in OHCA patients. This suggests that implementation of protocols to transport patients with OHCA directly to PCI centers, when feasible, may improve outcomes.