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Comparative Study
. 2020 Jun 2;9(11):e015544.
doi: 10.1161/JAHA.119.015544. Epub 2020 May 27.

Impact of Transport Time and Cardiac Arrest Centers on the Neurological Outcome After Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study

Cheng-Yu Chien  1   2   3 , Shang-Li Tsai  1   4 , Li-Heng Tsai  1 , Chen-Bin Chen  1 , Chen-June Seak  1 , Yi-Ming Weng  1   5 , Chi-Chun Lin  1   2 , Chip-Jin Ng  1 , Wei-Che Chien  1   4 , Chien-Hsiung Huang  1   5 , Cheng-Yu Lin  2 , Chung-Hsien Chaou  1 , Peng-Huei Liu  1   4 , Hsiao-Jung Tseng  6 , Chi-Tai Fang  7   3
Affiliations
Comparative Study

Impact of Transport Time and Cardiac Arrest Centers on the Neurological Outcome After Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study

Cheng-Yu Chien et al. J Am Heart Assoc. .

Abstract

Background Should all out-of-hospital cardiac arrest (OHCA) patients be directly transported to cardiac arrest centers (CACs) remains under debate. Our study evaluated the impacts of different transport time and destination hospital on the outcomes of OHCA patients. Methods and Results Data were collected from 6655 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City, Taiwan, between January 2012 and December 2016. Patients were matched on propensity score, which left 5156 patients, 2578 each in the CAC and non-CAC groups. Transport time was dichotomized into <8 and ≥8 minutes. The relations between the transport time to CACs and good neurological outcome at discharge and survival to discharge were investigated. Of the 5156 patients, 4215 (81.7%) presented with nonshockable rhythms and 941 (18.3%) presented with shockable rhythms. Regardless of transport time, transportation to a CAC increased the likelihoods of survival to discharge (<8 minutes: adjusted odds ratio [aOR], 1.95; 95% CI, 1.11-3.41; ≥8 minutes: aOR, 1.92; 95% CI, 1.25-2.94) and good neurological outcome at discharge (<8 minutes: aOR, 2.70; 95% CI, 1.40-5.22; ≥8 minutes: aOR, 2.20; 95% CI, 1.29-3.75) in OHCA patients with shockable rhythms but not in patients with nonshockable rhythms. Conclusions OHCA patients with shockable rhythms transported to CACs demonstrated higher probabilities of survival to discharge and a good neurological outcome at discharge. Direct ambulance delivery to CACs should thus be considered, particularly when OHCA patients present with shockable rhythms.

Keywords: cardiac arrest center; initial rhythm; neurological outcome; out‐of‐hospital cardiac arrest; transport time.

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Figures

Figure 1
Figure 1. Generalized additive model (GAM) plots showing the relationship between probability of having good Cerebral Performance Category (CPC) score and transport time in all out‐of‐hospital cardiac arrest patients.
The cut point obtained for the transport time was based on the relationship between transport time and probability of having a good CPC. The transport time for which there was an average probability of having a good CPC was 7.5 minutes.
Figure 2
Figure 2. Flow diagram of patient enrollment.
DNR indicates do not resuscitate.
Figure 3
Figure 3. Probability of good neurological outcome vs transport time from a restricted cubic spline model.
CPC indicates Cerebral Performance Category.
See this image and copyright information in PMC

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