Expedited transport versus continued on-scene resuscitation for refractory out-of-hospital cardiac arrest: A systematic review and meta-analysis

Abstract

Background: The benefit of rapid transport from the scene to definitive in-hospital care versus extended on-scene resuscitation in out-of-Hospital Cardiac Arrest (OHCA) is uncertain.

Aim: To assess the use of expedited transport from the scene of OHCA compared with more extended on-scene resuscitation of out-of-hospital cardiac arrest in adults.

Methods: A systematic search of the literature was conducted using MEDLINE, Embase, and SCOPUS. Randomised control trials (RCTs) and observational studies were included. Studies reporting transport timing for OHCA patients with outcome data on survival were identified and reviewed. Two investigators assessed studies identified by screening for relevance and assessed bias using the ROBINS-I tool. Studies with non-dichotomous timing data or an absence of comparator group(s) were excluded. Outcomes of interest included survival and favourable neurological outcome. Survival to discharge and favourable neurological outcome were meta-analysed using a random-effects model.

Results: Nine studies (eight cohort studies, one RCT) met eligibility criteria and were considered suitable for meta-analysis. On pooled analysis, expedited (or earlier) transfer was not predictive of survival to discharge (odds ratio [OR] 1.16, 95% confidence interval [CI] 0.53 to 2.53, I² = 99%, p = 0. 65) or favorable neurological outcome (OR 1.06, 95% CI 0.48 to 2.37, I² = 99%, p = 0.85). The certainty of evidence across studies was assessed as very low with a moderate risk of bias. Region of publication was noted to be a major contributor to the significant heterogeneity observed amongst included studies.

Conclusions: There is inconclusive evidence to support or refute the use of expedited transport of refractory OHCA.

Keywords: Adults; Cardiac Arrest; Cardiopulmonary Resuscitation; Curb to care; Emergency Medical Services; Expedited transport; Heart arrest; Humans; Load and go; Neurological outcome; Out of hospital; Out-of-hospital; Patient transport; Scoop and run; Stay and play; Survival; Transport of patients; Treatment outcome.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flowchart of systematic search and study selection.

Fig. 2

Survival to discharge. *Cardiac recovery at 30 days.

Fig. 3

Survival to 30 days. *CPC 1–2 reported at 30 days.

Fig. 4

CPC 1–2 on discharge.

Fig. 5

Effect of region of publication on survival to discharge or 30 days.

Fig. 6

Risk of bias assessments for included studies presented using A) ROBINS-I instrument for each observational study B) summary of ROBINS-I domains across observational studies C) Cochrane RoB 2 instrument for one randomized controlled trial.