Effect of transported hospital resources on neurologic outcome after out-of-hospital cardiac arrest
1Department of Emergency Medicine, Korea University Ansan Hospital, Ansan, Gyeonggi-do, South Korea
2 Department of Emergency Medicine, Inje University Ilsanpaik Hospital, Goyang-si, Gyeonggi-do, South Korea
3 EMS Information and Planning Team, National Emergency Medical Center, Seoul, South Korea
4 Department of Emergency Medicine, Seoul National University Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea
5Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, South Korea
DOI: 10.22514/SV151.042019.7 Vol.15,Issue 1,April 2019 pp.51-58
Published: 23 April 2019
Objective. Appropriate regional transport protocol for out-of-hospital cardiac arrest (OHCA) patients is important for achiev-ing favorable outcomes in a certain com-munity. This study aimed to investigate the effect of transported hospital resources on the neurologic outcome after OHCA. Methods. We categorized cardiac receiv-ing centers (CRC) in our community into two levels (primary [P-CRC] and definite CRC [D-CRC]) according to the hospital resources that were identified by the Hos-pital Assessment Survey in 2015. OHCA patients with presumed cardiac etiology resuscitated by emergency medical service providers between 2012 and 2014, were enrolled in the study. The main exposure was the level of CRC. The primary end-point was discharge with good neurologic outcomes. We compared outcomes be-tween CRCs after adjusting for potential confounders.
Results. Among the 9,912 patients, 5,876 were transported to P-CRC and 4,036 to D-CRC from 2012 to 2014. Patients admit-ted to D-CRC showed better neurologic outcome than those admitted to P-CRC (6.2% vs 1.5%, p<0.001). With regard to patients who survived to admission, the neurologic outcome of patients in D-CRC was better than those in P-CRC (11.3% vs 3.3%, p<0.001). In the multivariable logis-tic model, the adjusted odds ratio for all OHCA patients was 2.10 (95% confidence interval, 1.51–2.95).Conclusion. Transportation of OHCA pa-tients to the D-CRC resulted in significant-ly good neurologic outcome than those transported to P-CRC. Further research is needed to establish a regional OHCA transport protocol.
cardiac arrest, outcome, region-alization
JOO YEONG KIM,SUNGWOO MOON,JONG HAK PARK,HAN JIN CHO,JU HYUN SONG,WOOCHAN JEON,HANSOEK CHANG,YOUNG SUN RO,SANG DO SHIN. Effect of transported hospital resources on neurologic outcome after out-of-hospital cardiac arrest. Signa Vitae. 2019. 15(1);51-58.
1. Hazinski MF, Nolan JP, Billi JE, Böttiger BW, Bossaert L, de Caen AR, et al. Part 1: Executive summary: 2010 International consen-sus on cardiopulmonary resuscitation and emergency cardiovascular care Ssience with treatment recommendations. Circulation 2010;122:S250–S605.
2. Lee SY, Song KJ, Shin SD, Ro YS, Hong KJ, Kim YT, et al. A disparity in outcomes of out-of-hospital cardiac arrest by community socioeconomic status: A ten-year observational study. Resuscitation 2018;126:130–6.
3. Bernard SA, Gray TW, Buist MD, Jones BM, Silvester W, Gutteridge G, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med 2002;346:557–63.
4. Kim JY, Shin SD, Ro YS, Song KJ, Lee EJ, Park CB, et al. Post-resuscitation care and outcomes of out-of-hospital cardiac arrest: a nationwide propensity score-matching analysis. Resuscitation 2013;84:1068–77.
5. Testori C, Sterz F, Behringer W, Haugk M, Uray T, Zeiner A, et al. Mild therapeutic hypothermia is associated with favourable out-come in patients after cardiac arrest with non-shockable rhythms. Resuscitation 2011;82:1162–7.
6. Nichol G, Aufderheide TP, Eigel B, Neumar RW, Lurie KG, Bufalino VJ, et al. Regional systems of care for out-of-hospital cardiac arrest: A policy statement from the American Heart Association. Circulation 2010;121:709–29.
7. Bosson N, Kaji AH, Niemann JT, Eckstein M, Rashi P, Tadeo R, et al. Survival and neurologic outcome after out-of-hospital cardiac ar-rest: results one year after regionalization of post-cardiac arrest care in a large metropolitan area. Prehosp Emerg Care 2014;18:217–23.
8. Spaite DW, Bobrow BJ, Stolz U, Berg RA, Sanders AB, Kern KB, et al. Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome. Ann Emerg Med 2014;64:496–506.
9. Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation (American Heart Association, European Resus-citation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Circulation 2015;132:1286–300.
10. Donnino MW, Rittenberger JC, Gaieski D, Cocchi MN, Giberson B, Peberdy MA, et al. The development and implementation of cardiac arrest centers. Resuscitation 2011;82:974–8.
11. Kern KB. Usefulness of cardiac arrest centers – extending lifesaving post-resuscitation therapies: the Arizona experience. Circ J 2015;79:1156–63.
12. Elmer J, Rittenberger JC, Coppler PJ, Guyette FX, Doshi AA, Callaway CW, et al. Long-term survival benefit from treatment at a specialty center after cardiac arrest. Resuscitation 2016;108:48–53.
13. Park JH, Ahn KO, Shin SD, Song KJ, Ro YS, Kim JY, et al. A multicentre observational study of inter-hospital transfer for post-resuscitation care after out-of-hospital cardiac arrest. Resuscitation 2016;108:34–9.
14. Hartke A, Mumma BE, Rittenberger JC, Callaway CW, Guyette FX. Incidence of re-arrest and critical events during prolonged trans-port of post-cardiac arrest patients. Resuscitation 2010;81:938–42.
15. Mooney MR, Unger BT, Boland LL, Burke MN, Kebed KY, Graham KJ, et al. Therapeutic hypothermia after out-of-hospital cardiac arrest: evaluation of a regional system to increase access to cooling. Circulation 2011;124:206–14.
16. Spaite DW, Bobrow BJ, Vadeboncoeur TF, Chikani V, Clark L, Mullins T, et al. The impact of prehospital transport interval on sur-vival in out-of-hospital cardiac arrest: implications for regionalization of post-resuscitation care. Resuscitation 2008;79:61–6.
17. Spaite DW, Stiell IG, Bobrow BJ, de Boer M, Maloney J, Denninghoff K, et al. Effect of transport interval on out-of-hospital car-diac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers. Ann Emerg Med 2009;54:248–55.
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