Direct Transport to Cardiac Arrest Center and Survival Outcomes after Out-of-Hospital Cardiac Arrest by Urbanization Level.

Eujene Jung,Jeong Ho Park,Hyun Ho Ryu,Young Sun Ro,Sang Do Shin

doi:10.3390/jcm11041033

Abstract

Current guidelines for post-resuscitation care recommend regionalized care at a cardiac arrest center (CAC). Our objectives were to evaluate the effect of direct transport to a CAC on survival outcomes of out-of-hospital cardiac arrests (OHCAs), and to assess interaction effects between CAC and urbanization levels. Adult EMS-treated OHCAs with presumed cardiac etiology between 2015 and 2019 were enrolled. The main exposure was the hospital where OHCA patients were transported by EMS (CAC or non-CAC). The outcomes were good neurological recovery and survival to discharge. Multivariable logistic regression analyses were conducted. Interaction analysis between the urbanization level of the location of arrest (metropolitan or urban/rural area) and the exposure variable was performed. Among the 95,931 study population, 23,292 (24.3%) OHCA patients were transported directly to CACs. Patients in the CAC group had significantly higher likelihood of good neurological recovery and survival to discharge than the non-CAC group (both p < 0.01, aORs (95% CIs): 1.75 (1.63–1.89) and 1.70 (1.60–1.80), respectively). There were interaction effects between CAC and the urbanization level for good neurological recovery and survival to discharge. Direct transport to CAC was associated with significantly better clinical outcomes compared to non-CAC, and the findings were strengthened in OHCAs occurring in nonmetropolitan areas.

Highlights

Out-of-hospital cardiac arrest (OHCA) is a major global health problem, with high incidence and poor survival outcomes [1,2]
Regional systems of care involving centralization of post-resuscitation care have been proposed to improve survival outcomes of OHCA, as OHCA is considered to be best treated in regional hospitals with highly resource-intensive treatments such as extracorporeal membrane oxygenation, percutaneous cardiac intervention (PCI), and targeted temperature management (TTM) [5,6]
This study identified a study population using the Korean nationwide OHCA registry, which captures all emergency medical services (EMS)-assessed OHCA patients across the country

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a major global health problem, with high incidence and poor survival outcomes [1,2]. Personnel are responsible for on-scene and during-transport resuscitation and transporting of OHCA patients to the appropriate hospital for post-resuscitation care [4]. Regional systems of care involving centralization of post-resuscitation care have been proposed to improve survival outcomes of OHCA, as OHCA is considered to be best treated in regional hospitals with highly resource-intensive treatments such as extracorporeal membrane oxygenation, percutaneous cardiac intervention (PCI), and targeted temperature management (TTM) [5,6]. Current guidelines for post-resuscitation care recommend regionalization to designated cardiac arrest centers (CAC) that can provide 24 h immediate. Sudden cardiac arrest is one of the most time-sensitive diseases, and the increased transport time interval in bypassing the nearest hospital to reach the destination hospital may be detrimental for some OHCA patients with specific conditions [10]

Objectives

Methods

Results

Conclusion