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. 2024 Apr 6:18:100625.
doi: 10.1016/j.resplu.2024.100625. eCollection 2024 Jun.

Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study

Bridget Dicker  1   2 , Nick Garrett  2 , Graham Howie  1   2 , Aroha Brett  1 , Tony Scott  3 , Ralph Stewart  4 , Gavin D Perkins  5 , Tony Smith  1 , Elena Garcia  1 , Verity F Todd  1   2
Affiliations

Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study

Bridget Dicker et al. Resusc Plus. .

Abstract

Background and objectives: Direct transport to a cardiac arrest centre following out-of-hospital cardiac arrest may be associated with higher survival. However, there is limited evidence available to support this within the New Zealand context. This study used a propensity score-matched cohort to investigate whether direct transport to a cardiac arrest centre improved survival in New Zealand.

Methods: A retrospective cohort study was conducted using the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) database for adults treated for out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 July 2018 to 30 June 2023. Propensity score-matched analysis was used to investigate survival at 30-days post-event according to the receiving hospital being a cardiac arrest centre versus a non-cardiac arrest centre.

Results: There were 2,297 OHCA patients included. Propensity matching resulted in 554 matched pairs (n = 1108). Thirty-day survival in propensity score-matched patients transported directly to a cardiac arrest centre (56%) versus a non-cardiac arrest centre (45%) was not significantly different (adjusted Odds Ratio 0.78 95%CI 0.54, 1.13, p = 0.19). Shockable presenting rhythm, bystander CPR, and presence of STEMI were associated with a higher odds of 30 day survival (p < 0.05). Māori or Pacific Peoples ethnicity and older age were associated with lower survival (p < 0.05).

Conclusions: This study found no statistically significant difference in outcomes for OHCA patients transferred to a cardiac arrest compared to a non-cardiac arrest centre. However, the odds ratio of 0.78, equivalent to a 22% decrease in 30-day mortality, is consistent with benefit associated with management by a cardiac arrest centre. Further research in larger cohorts with detailed information on known outcome predictors, or large randomised clinical trials are needed.

Keywords: Aotearoa; Cardiac arrest; Cardiac arrest centre; EMS; New Zealand; Out of hospital; Paramedic; Resuscitation.

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Conflict of interest statement

The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: [GDP is Editor in Chief of Resuscitation Plus and supported by NIHR ARC West Midlands. BD - Is a Co-guest editor for Resuscitation Plus. BD, EG, AB and T-Smith are employees of Hato Hone St John. Other authors, declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.].

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