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

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.

Updates on Post-Resuscitation Care. After the Return of Spontaneous Circulation beyond the 2021 Guidelines

“…These hospitals will be called cardiac arrest centres (CAC) in the following years both in the US [ 71 ] and in Europe [ 72 , 73 ]. A recent study from Korea [ 74 ] on a vast sample of patients (more than 95,000) showed that the direct transport to a CAC was associated with an increased survival of about two times. Interestingly, at least for patients with a shockable presenting rhythm, the benefit in survival was independent of the time needed to reach the CAC, meaning that a longer transport but to a CAC was preferable to a shorter transfer but to a non-CAC [non-CAC 8 min; non-CAC 8 min: OR 0.40 (95% CI 0.12–1.32); CAC 8 min: OR 1.92 (95% CI 1.26–2.94); CAC 8 min: OR 1.78 (95% CI 1.03–3.10)] [ 75 ].…”