Regional Impact of Cardiac Arrest Center Criteria on Out-of-Hospital Transportation Practices

Abstract

Background. Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post–cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols have been associated with improved outcomes. Objectives. This study aimed 1) to identify the PCA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation and 2) to determine the proportion of PCA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria. Methods. We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PCA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, nontrauma cardiac arrest patients transported with a pulse from 2006 to 2008 for 16 EMS agencies. The proportions of patients transported to hospitals meeting three CAC criteria were compared: criteria A (availability of CATH and TH), criteria B (criteria A, >200 CATHs per year, and a PCA protocol), and criteria C (criteria B and a 24-hour intensivist). Results: Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met criteria A, seven (22.6%) met criteria B, and six (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded because of transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 patients (66.1%) transported to hospitals meeting criteria C. Conclusions. In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH), but those facilities receive 81% of PCA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.