Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology

McKenzie, Nicole; Williams, Teresa A.; Ho, Kwok M.; Inoue, Madoka; Bailey, Paul; Celenza, Antonio; Fatovich, Daniel M; Jenkins, Ian; Finn, Judith

doi:10.1016/j.resuscitation.2018.04.039

Cited by 40 publications

(27 citation statements)

References 20 publications

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“…[38,39] Two studies using an indirect measure (discharge destination) also favoured care at CACs for this outcome. [40,41]…”

Section: Survival At 30 Days With Favourable Neurological Outcomes (Cmentioning

confidence: 99%

“…The majority of the included studies compared OHCA patients who were directly transport to a CAC to those transported to a non-CAC. Only three studies examined outcomes in OHCA patients who were transferred to a CAC from a non-CAC [33,36,41]. In these studies, the proportion of patients with secondary transfers were small and, although two studies [33,41] adjusted for available confounders, there is potential for referral bias (whereby the sickest or those most likely to survive were transferred to CACs).…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

“…Only three studies examined outcomes in OHCA patients who were transferred to a CAC from a non-CAC [33,36,41]. In these studies, the proportion of patients with secondary transfers were small and, although two studies [33,41] adjusted for available confounders, there is potential for referral bias (whereby the sickest or those most likely to survive were transferred to CACs). A US study [33] reported no difference in long-term survival between primary and secondary transfers to CACs after adjusting for potential confounders (or in unadjusted 30-day survival data provided by the authors).…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

“…After conducting numerous analyses to adjust for referral bias, but the study consistently reported increased long-term survival in patients cared for at CACs, with the lowest mortality seen in early transfers. An Australian study [41] reported higher (adjusted) survival in patients who were transferred directly to a CAC compared to secondary…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

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Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

et al. 2019

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Please cite this article as: Yeung J, Matsuyama T, Bray J, Reynolds J, Skrifvars MB, Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? -A systematic review, Resuscitation (2019), https://doi.on behalf of the Education, Implementation and Team Task Force and Advanced Life Support Task Force of the International Liaison Committee on Resuscitation AIMTo perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' METHODSThe PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1 st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTSWe included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95%CI 0.68 to 12.48) and survival to 30 days (OR 2.14, 95%CI 0.73 to 6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95%CI 1.74 to 2.84) and survival to hospital discharge (OR 1.85, 95%CI 1.46 to 2.34). CONCLUSIONSVery low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.

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“…[38,39] Two studies using an indirect measure (discharge destination) also favoured care at CACs for this outcome. [40,41]…”

Section: Survival At 30 Days With Favourable Neurological Outcomes (Cmentioning

confidence: 99%

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

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Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

et al. 2019

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“…Four observational studies examined the potential impact of transfer on patient outcomes after OH-CA. 189,199,209,211 One study 211 reported higher adjusted patient survival associated with direct transfer to a CAC compared with patient survival among those who underwent secondary interfacility transfer (odds ratio, 1.97 [95% CI, 1.13À3.43]). Two other studies 189,199 reported no difference in survival between direct transport and secondary transfer of patients to a CAC.…”

Section: [ 4 7 _ T D $ D I F F ] Eit and Als Task Forcesmentioning

confidence: 99%

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Soar¹,

Maconochie²,

Wyckoff³

et al. 2019

Resuscitation

131

113

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The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research.

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Early risk stratification after resuscitation from cardiac arrest

et al. 2020

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Emergency clinicians often resuscitate cardiac arrest patients, and after acute resuscitation, clinicians face multiple decisions regarding disposition. Recent evidence suggests that out‐of‐hospital cardiac arrest patients with return of spontaneous circulation have higher odds of survival to hospital discharge, long‐term survival, and improved functional outcomes when treated at centers that can provide advanced multidisciplinary care. For community clinicians, a high volume cardiac arrest center may be hours away. While current guidelines recommend against neurological prognostication in the first hours or days after return of spontaneous circulation, there are early findings suggestive of irrecoverable brain injury in which the patient would receive no benefit from transfer. In this Concepts article, we describe a simplified approach to quickly evaluate neurological status in cardiac arrest patients and identify findings concerning for irrecoverable brain injury. Characteristics of the arrest and resuscitation, initial neurological assessment, and brain computed tomography together can identify patients with high likelihood of irrecoverable anoxic injury. Patients who may benefit from centers with access to continuous electroencephalography are discussed. This approach can be used to identify patients who may benefit from rapid transfer to cardiac arrest centers versus those who may benefit from care close to home. Risk stratification also can provide realistic expectations for recovery to families.

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Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology

Cited by 40 publications

References 20 publications

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

Early risk stratification after resuscitation from cardiac arrest

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