Bypassing out-of-hospital cardiac arrest patients to a regional cardiac center: Impact on hemodynamic parameters and outcomes

Karásek, Jiří; Seiner, Jiří; Renza, Metoděj; Salanda, Frantisek; Moudry, Martin; Strýček, Matej; Lejsek, Jan; Polášek, Rostislav; Ošťádal, Petr

doi:10.1016/j.ajem.2021.01.080

Cited by 4 publications

(5 citation statements)

References 23 publications

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“…Although transport to a CAC improves outcomes, it remains unclear if EMS should bypass the nearest emergency departments in favor of CACs. 57 , 78 It has been suggested that the increase in transport time caused by bypassing the nearest hospital does not substantially affect outcomes after transport to CACs. 23 , 42 , 57 , 76 , 79 Other options include initial transport to a non‐CAC with eventual interhospital transfer to a CAC, which seemed to have similar outcomes in this review, 44 , 49 but more definitive evidence is required to confirm this finding, in the form of an interventional trial comparing ambulance diversion strategies.…”

Section: Discussionmentioning

confidence: 99%

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Yeo

Goh

et al. 2022

JAHA

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Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

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Section: Discussionmentioning

confidence: 99%

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Yeo

Goh

et al. 2022

JAHA

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“…OHCA patients admitted to hospitals with PCI facilities have increased access to early coronary angiography, specialist input, and better outcomes 7,25,26 . However, there are limited data around the association between hospital overall PCI volume and OHCA PCI volume in contemporary practice.…”

Section: Discussionmentioning

confidence: 99%

Variation in practice for out‐of‐hospital cardiac arrest treated with percutaneous coronary intervention in England and Wales

Rashid

Kinnaird

Ludman

et al. 2022

Cathet Cardio Intervent

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Objectives: We assessed the association between total center volume, operator volume, and out-of-hospital cardiac arrest (OHCA) percutaneous coronary intervention (PCI) volume.Background: Variations between OHCA PCI volume, hospital total PCI, and primary PCI volume are not well studied and are unlikely to be clinically justifiable. Methods: Patients undergoing PCI for the acute coronary syndrome (ACS) between January 1, 2014, and March 31, 2019, in England and Wales were grouped as OHCA PCI and non-OHCA PCI. Spearman's correlation was used to determine the degree of correlation between each hospital PCI volume and OHCA PCI volume.Results: Out of 250,088 PCI procedures undertaken for ACS, 12,016 (4.8%) were performed for OHCA, and 238,072 (95.2%) were non-OHCA PCI procedures. The OHCA PCI group were younger [mean age (SD) 63.2 (12.3) and 65.6 (12.5, p < 0.001)], less likely to be female (20.2% vs. 26.9%, p < 0.001) or Black, Asian, and Minority Ethnicity (11.5% vs. 14.8%, p < 0.001) compared to the non-OHCA PCI group. Although there was a degree of correlation between total PCI and OHCA PCI, there was wide variation for both ACS cohort (Spearman correlation R 2 = 0.50) and total PCI volume (Spearman correlation R 2 = 0.60). Furthermore, the correlation between primary PCI volume and OHCA PCI within centers was weak (R 2 = 0.10).Similarly, wide variations between operator PCI volume and OHCA PCI volume were observed. Conclusion:These national data demonstrate wide variation in the practice of OHCA PCI both between centers and individuals. These variations are not expected according to clinical factors and require further investigation.

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“…Chien et al [53 && ] also applied a generalized additive model to find an optimal cut-off transport time, which was found to be 7.5 min, although previously Arizona cardiac receiving centres used a cut-off of 15 min [13]. Such evidence supports transport of the right patients to CACs even in less urban areas, for instance, where drive times to CACs are naturally longer [18,65,66]. Future studies should aim to standardize the measurement of transport times to streamline efforts to answer this question, especially since it stands to reason that the benefit of transport to CACs decreases with increasing transport time, presumably up to some maximum limit.…”

Section: Bypassing the Nearest Hospitalmentioning

confidence: 99%

“…Continuous quality improvement aimed towards improving compliance of care providers to these pathways has been shown to improve outcomes [14]. In 2020, the International Liaison Committee on Resuscitation (ILCOR) guidelines recommended the transport of OHCA patients to CACs [15 ], and there is no consensus on which patients would most benefit, or whether emergency medical services (EMS) should bypass the nearest hospital to transport patients to a CAC [17,18]. There is also a lack of consensus across previous literature on what constitutes a CAC [16 & ,19…”

Section: Introductionmentioning

confidence: 99%

“…In 2020, the International Liaison Committee on Resuscitation (ILCOR) guidelines recommended the transport of OHCA patients to CACs [15 ▪ ]. However, this was a weak recommendation based on very low certainty evidence [16 ▪ ], and there is no consensus on which patients would most benefit, or whether emergency medical services (EMS) should bypass the nearest hospital to transport patients to a CAC [17,18]. There is also a lack of consensus across previous literature on what constitutes a CAC [16 ▪ ,19 ▪▪ ,20], although research on CACs has steadily advanced in recent years.…”

Section: Introductionmentioning

confidence: 99%

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Cardiac arrest centres: what, who, when, and where?

Yeo

Ong

2022

Current Opinion in Critical Care

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Purpose of reviewCardiac arrest centres (CACs) may play a key role in providing postresuscitation care, thereby improving outcomes in out-of-hospital cardiac arrest (OHCA). There is no consensus on CAC definitions or the optimal CAC transport strategy despite advances in research. This review provides an updated overview of CACs, highlighting evidence gaps and future research directions.Recent findingsCAC definitions vary worldwide but often feature 24/7 percutaneous coronary intervention capability, targeted temperature management, neuroprognostication, intensive care, education, and research within a centralized, high-volume hospital. Significant evidence exists for benefits of CACs related to regionalization. A recent meta-analysis demonstrated clearly improved survival with favourable neurological outcome and survival among patients transported to CACs with conclusions robust to sensitivity analyses. However, scarce data exists regarding ‘who’, ‘when’, and ‘where’ for CAC transport strategies. Evidence for OHCA patients without ST elevation postresuscitation to be transported to CACs remains unclear. Preliminary evidence demonstrated greater benefit from CACs among patients with shockable rhythms. Randomized controlled trials should evaluate specific strategies, such as bypassing nearest hospitals and interhospital transfer.SummaryReal-world study designs evaluating CAC transport strategies are needed. OHCA patients with underlying culprit lesions, such as those with ST-elevation myocardial infarction (STEMI) or initial shockable rhythms, will likely benefit the most from CACs.

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Bypassing out-of-hospital cardiac arrest patients to a regional cardiac center: Impact on hemodynamic parameters and outcomes

Cited by 4 publications

References 23 publications

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Variation in practice for out‐of‐hospital cardiac arrest treated with percutaneous coronary intervention in England and Wales

Cardiac arrest centres: what, who, when, and where?

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