Do Out‐of‐Hospital Cardiac Arrest Patients Have Increased Chances of Survival When Transported to a Cardiac Resuscitation Center?

Abstract

Background Patients suffering from an out‐of‐hospital cardiac arrest are often transported to the closest hospital. Although it has been suggested that these patients be transported to cardiac resuscitation centers, few jurisdictions have acted on this recommendation. To better evaluate the evidence on this subject, a systematic review and meta‐analysis of the currently available literature evaluating the association between the destination hospital's capability (cardiac resuscitation center or not) and resuscitation outcomes for adult patients suffering from an out‐of‐hospital cardiac arrest was performed. Methods and Results PubMed, EMBASE , and the Cochrane Library databases were first searched using a specifically designed search strategy. Both original randomized controlled trials and observational studies were considered for inclusion. Cardiac resuscitation centers were defined as having on‐site percutaneous coronary intervention and targeted temperature management capability at all times. The primary outcome measure was survival. Twelve nonrandomized observational studies were retained in this review. A total of 61 240 patients were included in the 10 studies that could be included in the meta‐analysis regarding the survival outcome. Being transported to a cardiac resuscitation center was associated with an increase in survival (odds ratio=1.95 [95% confidence interval 1.47‐2.59], P <0.001). Conclusions Adult patients suffering from an out‐of‐hospital cardiac arrest transported to cardiac resuscitation centers have better outcomes than their counterparts. When possible, it is reasonable to transport these patients directly to cardiac resuscitation centers (class II a, level of evidence B, nonrandomized). Clinical Trial Registration URL : http://www.crd.york.ac.uk/PROSPERO/ . Unique identifier: CRD 42018086608.

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

“…Regionalized systems of post-resuscitation care have been proposed to improve survival outcomes of OHCAs through centralization of highly resource-intensive treatments such as TTM, acute cardiac care including PCI, and multimodal neuro-intensive care. In recent systematic review and meta-analysis, direct transport of OHCA patients to CACs by EMS providers was associated with increased survival outcomes, despite very low certainty of evidence [8,9]. In meta-analysis studies, the definition of CAC varied from study to study, and the capability of PCI was essential, while availability for TTM was treated as important.…”

“…Current guidelines for post-resuscitation care recommend regionalization to designated cardiac arrest centers (CAC) that can provide 24 h immediate PCI and can provide TTM [5,7]. However, in recent systematic review and meta-analysis studies, it was suggested that while transporting patients directly to a CAC did associate with improved clinical outcomes at hospital discharge, it did not improve 1-month survival outcomes [8,9]. 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].…”

An Overview of Therapy Guidelines for Cardiac Arrest and the Potential Benefits of Hemoglobin-Based Oxygen Carriers

“…It has been shown that survival to hospital discharge is improved for OOHCA that is witnessed by a bystander/EMS (Emergency Medical Service), in patients who received bystander CPR, in patients with shockable rhythms, and in patients who were able to achieve in-field return of spontaneous circulation (ROSC) [10]. Furthermore, it has been shown that patients who suffer from OOHCA have improved outcomes when transported to medical centers that are specialized and capable of managing cardiac resuscitation with available services such as cardiac catheterization [11]. When considering IHCA, the chain of survival is not as prominent in ensuring improved survival, as patients theoretically are already at the highest level of care required to manage this condition.…”

Postarrest Interventions that Save Lives

“…1 Transport to a cardiac resuscitation center has been associated with increased survival and improved short-and long-term outcomes. [81][82][83][84][85] These specialty care centers can offer PCI, cardiac and neurologic critical care and TTM. For unstable patients, active engagement of a critical care transport team is crucial when arranging interfacility transport.…”