Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest

Cournoyer, Alexis; Notebaert, Éric; Montigny, Luc de; Ross, Dolorosa Maria; Cossette, Sylvie; Londei-Leduc, Luc; Iseppon, Massimiliano; Lamarche, Yoan; Sokoloff, Catalina; Potter, Brian J.; Vadeboncœur, Alain; Larose, D.; Morris, Judy; Daoust, Raoul; Chauny, Jean‐Marc; Piette, Éric; Paquet, Jean; Cavayas, Yiorgos Alexandros; Champlain, François de; Segal, Eli; Albert, Martin; Guertin, Marie-Claude; Denault, André

doi:10.1016/j.resuscitation.2018.01.048

Cited by 53 publications

(39 citation statements)

References 33 publications

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“…Data were too heterogeneous to allow for meta-analysis (Supplementary Materials Table 3). In patients with shockable rhythm, four studies reported improved outcomes at CACs [36,48,49,51], and three studies reported no difference [37,45,50]. In patients with nonshockable initial rhythms, CACs were associated with improved outcomes in one study [51] and no difference in two studies [49,50].…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 97%

“…Survival to hospital discharge was reported in ten studies (three retrospective cohort studies and two before and after studies with adjusted analyses, and five retrospective analyses with unadjusted analyses) including 42780 patients. [38][39][40][45][46][47][48][49][50] Data from meta-analysis of 5 studies (n=11,662)…”

Section: Survival To Hospital Discharge (Critical)mentioning

confidence: 99%

“…Eight studies [33,36,37,45,[48][49][50][51] reported outcomes in CAC versus non-CACs stratified by shockable or non-shockable rhythms. Data were too heterogeneous to allow for meta-analysis (Supplementary Materials Table 3).…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

“…[43] In contrast, regression analyses from Cournoyer study stated that increasing the delay from call to hospital arrival by 14.0 min would offset the potential survival benefit of being transported to a PCI-capable centre. [50] The decision whether to transport a patient and the hospital destination are likely to differ in urban, suburban, and rural settings. [55] Appropriately validated decision-making and risk prediction tools may help guide rescuers with transport and treatment decisions in future studies.…”

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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Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 97%

Section: Survival To Hospital Discharge (Critical)mentioning

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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“…10,11 There has been growing evidence of the relationship between hospitals' capabilities for medical practice, such as PCI capability and the level of intensive care, and survival. [12][13][14][15][16][17][18][19][20] Although some studies have demonstrated that the receiving hospital's characteristics were associated with better outcomes for OHCA patients, [12][13][14][15][16][17] others failed to show such a relationship between the hospital's capacity and outcomes. [13][14][15][16][17][18][19][20] The discrepancy still remains unresolved.…”

Section: Introductionmentioning

confidence: 99%

Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

Matsuoka¹,

Ikenoue

Hata

et al. 2019

Resuscitation

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Aim: Extracorporeal cardiopulmonary resuscitation (ECPR) is the emerging resuscitative strategy to save refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) patients. We investigated whether the receiving hospitals' ECPR capabilities are associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients who have refractory VF or pulseless VT. Methods: In a population-based cohort study performed in Kobe City, Japan, between 2010 and 2017, we identified all OHCA patients who had refractory VF or pulseless VT. Based on their ECPR capabilities, hospitals were categorised into ECPR facilities and conventional cardiopulmonary resuscitation (CCPR) facilities. We compared patient survivals between ECPR facilities and CCPR facilities by applying inverse probability weighting using a propensity score. Results: Of all 10,971 OHCA patients, 518 had refractory VF or pulseless VT. The proportion of favourable neurologic outcomes was 43/188 (22.9%) in ECPR facilities and 28/330 (8.5%) in CCPR facilities. In the propensity analysis, hospitals' ECPR capabilities were associated with favourable neurologic outcomes (adjusted risk difference [ARD], 9.7% [95% confidence interval [CI], 3.7%-15.7%]; adjusted risk ratio [ARR], 2.01 [95% CI, 1.31-3.09]), and overall survival (87/188 [46.3%] vs. 67/330 [20.3%]; ARD, 19.0% [95% CI, 11.1%-26.9%]; ARR, 1.88 [95% CI, 1.45-2.44]). Conclusions: Hospitals' ECPR capabilities were associated with favourable neurologic outcomes in OHCA patients who had refractory VF or pulseless VT. We should take each hospital's ECPR capability into consideration when developing a regional system of care for OHCA.

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Getting the Right Patient to the Right Place in the Right Amount of Time—A Role for Both Mobile Stroke Units and Prehospital Clinical Scales

McMullan

Khatri

2019

JAMA Neurol

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Fundamentally, emergency medical services (EMS) specialize in triage, with a goal of getting the right patient to the right place in the right amount of time. This art of triage may bypass the closest facility for the most appropriate facility and, when performed correctly, improves outcomes after trauma, 1 acute myocardial infarction, 2 and out-of-hospital cardiac arrest. 3 Proper EMS triage can be the most cost-effective strategy in developing systems of care and is favored over creation of additional specialty-receiving facilities. 4 More than half of all patients with acute stroke and most patients with severe stroke arrive at the hospital via EMS. 5 Twenty years ago, prehospital stroke identification and triage was simple because treatment decisions were simple: apply a sensitive, objective clinical decision aid, such as the Cincinnati Prehospital Stroke Scale or the Los Angeles Prehospital Stroke Screen, 6 and, if positive, transport the patient to a hospital capable of administering tissue plasminogen activator. As new treatment options have been established (eg, endovascular therapy) 7 and patient selection has expanded, 8,9 prehospital tools must also evolve.Since 2017, the American Heart Association/American Stroke Association Mission: Lifeline Stroke campaign 10 has recommended use of a stroke severity scale to help EMS professionals identify patients who may benefit from bypassing a closer hospital in favor of one offering more advanced capabilities. While several instruments have been developed, 11 prospective validation in prehospital patients with suspected stroke is limited, and there is insufficient evidence to choose one over another. 7,11,12 These tools demonstrate similar performance, with roughly 70% sensitivity and specificity in predicting which patients with suspected stroke may benefit from comprehensive stroke centers (CSCs); naturally, this translates into 30% overtriage and undertriage rates. Based on current treatment trends, a 5% increase in prehospital triage tool sensitivity translates to an approximate 30% relative increase in appropriate triage of patients with severe stroke; in the United States, thousands more patients with acute ischemic stroke due to large-vessel occlusion (LVO) could be treated with endovascular therapy, and half of treated patients are expected to have less disability due to stroke than without treatment. 13 Concurrent with clinical tool development, the first mobile stroke units (MSUs) appeared. 14 The MSUs "flip the script" by bringing the capabilities of an acute stroke-ready hospital to select patients instead of EMS bringing patients to select hospitals. Early accounts demonstrate significantly improved tis-

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Impact of the direct transfer to percutaneous coronary intervention-capable hospitals on survival to hospital discharge for patients with out-of-hospital cardiac arrest

Cited by 53 publications

References 33 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

Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

Getting the Right Patient to the Right Place in the Right Amount of Time—A Role for Both Mobile Stroke Units and Prehospital Clinical Scales

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