Survival analysis in out-of-hospital cardiac arrest patients with shockable rhythm directly transport to Heart Centers
1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, 333 Tao-Yuan, Taiwan
2Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Taiwan
3Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, 236 New Taipei City, Taiwan
4Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, 33004 Taoyuan, Taiwan
5Department of Emergency Medicine, Ton-Yen General Hospital, 302 Zhubei, Taiwan
6Biostatistical Unit, Clinical Trial Center, Chang Gung Memorial Hospital, 333 Linkou, Taiwan
DOI: 10.22514/sv.2021.084 Vol.17,Issue 5,September 2021 pp.95-102
Submitted: 12 March 2021 Accepted: 29 March 2021
Published: 08 September 2021
† These authors contributed equally.
Background: This study aimed to evaluate whether out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm without prehospital return of spontaneous circulation (ROSC) who are directly transported to Heart Centers in appropriate time will have better post-cardiac arrest four months survival and neurological outcomes at discharge.
Methods: This retrospective study assessed the data of 1,588 OHCA patients with shockable rhythm and without prehospital ROSC collected from the registry database of Taoyuan City between January 2014 and June 2018. The relationships of transport time to Heart Centers with survival at discharge and with neurological outcomes were investigated for survival analysis.
Results: Among the 1,588 OHCA patients with initial shockable rhythm and without prehospital ROSC, 1,222 (77.0%) and 366 (23.0%) were transported to Heart Centers and non-Heart Centers, respectively. However, the transport to Heart Centers was associated with an increased survival at discharge (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI], 1.42–2.81) and good neurological outcomes (cerebral performance category [CPC] 1 and 2) (aOR 3.14, 95% CI, 1.88–5.23), regardless of the transport time. The overall mortality reduction for Heart Centers was 39% (hazard ratio [HR] = 0.61; 95% CI 0.47–0.78), compared to that for non-Heart Centers. At 120 days of follow-up, the results showed a higher survival rate for patients who were transported to Heart Centers within a short time. The percentages of good CPC showed a better distribution for non-Heart Centers versus those for Heart Centers.
Conclusions: Adult OHCA patients with initial shockable rhythm and without prehospital ROSC who were transported to Heart Centers directly had better post-cardiac arrest survival and good neurologic outcomes, regardless of the transport time.
Out-of-hospital cardiac arrest; Heart Centers; Transport time; Survival at discharge
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