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Meta-Analysis
. 2018 Dec 4;7(23):e011079.
doi: 10.1161/JAHA.118.011079.

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

Demis Lipe  1 , Al Giwa  2   3 , Nicholas D Caputo  4 , Nachiketa Gupta  2   3 , Joseph Addison  5 , Alexis Cournoyer  6   7   8
Affiliations
Meta-Analysis

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

Demis Lipe et al. J Am Heart Assoc. .

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 : www.crd.york.ac.uk/PROSPERO/ . Unique identifier: CRD 42018086608.

Keywords: cardiac arrest; emergency medical services; percutaneous coronary intervention; resuscitation; sudden cardiac arrest.

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Figures

Figure 1
Figure 1
Flow diagram of the systematic search.
Figure 2
Figure 2
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, performed using a random‐effect model.22, 23, 24, 25, 26, 27, 30, 31, 32, 33 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 3
Figure 3
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, performed using a fixed‐effect model.22, 23, 24, 25, 26, 27, 30, 31, 32, 33 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 4
Figure 4
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, performed using a random‐effect model.22, 24, 28, 30, 31 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 5
Figure 5
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, performed using a fixed‐effect model.22, 24, 28, 30, 31 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 6
Figure 6
Funnel plot for the evaluation of publication bias for the survival outcome.
Figure 7
Figure 7
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, excluding studies with some risk of bias, performed using a random‐effect model.22, 23, 24, 25, 26, 27, 30, 31, 32, 33 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 8
Figure 8
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, excluding studies with some risk of bias, performed using a fixed‐effect model.22, 23, 24, 25, 26, 27, 30, 31, 32, 33 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 9
Figure 9
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, excluding studies with some risk of bias, performed using a random‐effect model.22, 24, 28, 30, 31 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 10
Figure 10
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, excluding studies with some risk of bias, performed using a fixed‐effect model.22, 24, 28, 30, 31 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 11
Figure 11
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, including only patients who experienced prehospital return of spontaneous circulation, performed using a random‐effect model.22, 23, 26, 27, 32 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 12
Figure 12
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, including only patients who experienced prehospital return of spontaneous circulation, performed using a fixed‐effect model.22, 23, 26, 27, 32 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 13
Figure 13
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, including only patients who experienced prehospital return of spontaneous circulation, performed using a random‐effect model.22 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 14
Figure 14
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, including only patients who experienced prehospital return of spontaneous circulation, performed using a fixed‐effect model.22 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 15
Figure 15
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, including only patients who did not experience prehospital return of spontaneous circulation, performed using a random‐effect model.22, 25, 30, 32 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 16
Figure 16
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival, including only patients who did not experience prehospital return of spontaneous circulation, performed using a fixed‐effect model.22, 25, 30, 32 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 17
Figure 17
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, including only patients who did not experience prehospital return of spontaneous circulation, performed using a random‐effect model.22 CI indicates confidence interval; IV, inverse variance; SE, standard error.
Figure 18
Figure 18
Meta‐analysis evaluating the association between transport to a cardiac resuscitation center and survival with a good neurologic outcome, including only patients who did not experience prehospital return of spontaneous circulation, performed using a fixed‐effect model.22 CI indicates confidence interval; IV, inverse variance; SE, standard error.
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