Abstract 3: Impact Of Transport To Critical Care Centers Vs. Non-critical Care Hospitals On Outcomes From Out-of-hospital Cardiac Arrest In Osaka, Japan

Abstract

Background: Recent studies suggest that specialized hospital care including hypothermia and early percutaneous coronary intervention (PCI) influences the outcome of out-of -hospital cardiac arrest (OHCA) patients. In Japan, selected hospitals are certificated as “Critical Care Centers (CCC)” based on their expertise and ability to provide these higher levels of care. We hypothesized that the outcomes of patients with OHCA who were transported to CCC is better than if they were transported to non-critical care hospitals (NCCH) in Osaka, Japan. Materials and Methods: All adults with OHCA of presumed cardiac etiology, treated by the emergency medical services (EMS) systems, and transported to a hospital in Osaka, Japan from January 1, 2005 to December 31, 2006 were studied using a prospective Utstein style population cohort database. Primary outcome measure was one month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCC were compared to patients transported to NCCH using multiple logistic regression to adjust for the following confounding variables; gender, age, witnessed status, bystander CPR, location, transport time and initial rhythm. We also performed a stratified analysis based on whether the patients achieved ROSC prior to arrival at the hospital. Results: Of 6,943 OHCA of presumed cardiac etiology, 6,706 cases were transported. Of these, 1,780 were transported to CCC while 4,926 were transported to NCCH. Neurologically favorable survival at one-month was greater in the CCC group [103 (5.8 %) versus 119 (2.4 %), p < 0.001]. Transportation to CCC was a significant predictor [OR = 1.7, 95% CI interval (1.3 – 2.4)] of neurologically favorable survival after adjustment for confounding variables. In the stratified analysis, the impact of the CCC was not significant difference in patients transported after field ROSC. [OR = 1.4, 95% CI interval (0.92 – 2.22)] On the other hand, the impact of the CCC was even greater in patients transported prior to field ROSC. [OR = 2.4, 95% CI interval (1.3 – 4.5)] Conclusions: The outcomes of patients with OHCA with or without field ROSC who were transported to Critical Care Centers was better than if they were transported to Non-Critical Care Hospitals.