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. 2010 May;81(5):518-23.
doi: 10.1016/j.resuscitation.2009.12.030. Epub 2010 Feb 1.

A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers

Michael T Cudnik  1 , Robert H Schmicker, Christian Vaillancourt, Craig D Newgard, James M Christenson, Daniel P Davis, Robert A Lowe; ROC Investigators
Affiliations

A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers

Michael T Cudnik et al. Resuscitation. 2010 May.

Abstract

Objectives: National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity.

Methods: Prospective, cohort study of OOHCA patients in 11 Resuscitation Outcomes Consortium (ROC) sites across North America. Transport distance and hospital proximity was calculated using weighted centroid of census tract location by Geographic Information Systems (GIS). Patients were stratified into quartiles based on transport distance to the receiving hospital calculated via GIS. Descriptive statistics were used to describe characteristics by transport distance and to compare proximity to other hospitals. Multivariate logistic regression was used to evaluate the impact of transport distance on survival.

Results: 26,628 patients were identified, 7540 (28%) were transported by EMS and included in the final analysis. The median transport time was 6.3 min (IQR 5.4); the median transport distance being 2.4 miles (3.9 km). Most patients were taken to the closest hospital (71.7%; N=5412). However, unadjusted survival to discharge was lower for those taken to the closest compared to further hospitals (12.1% vs. 16.5%) despite similar patient characteristics. Transport distance was not associated with survival on logistic analysis (OR 1.00; 95% CI 0.99-1.01).

Conclusions: Survival to discharge was higher in OOHCA patients taken to hospitals located further than the closest hospital while transport distance was not associated with survival. This suggests that longer transport distance/time might not adversely affect outcome. Further studies are needed to inform policy decisions regarding best destination post-cardiac arrest.

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Conflict of interest statement

Conflict of Interest Statement

None of the authors of this paper have any financial or personal relationships with other people or organizations that could inappropriately influence (bias) this paper.

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Figure 1
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