Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers

Elmer, Jonathan; Callaway, Clifton W.; Chang, Chung‐Chou H.; Madaras, Jonathan; Martin‐Gill, Christian; Nawrocki, Philip S.; Seaman, Kristen A.C.; Sequeira, Denisse J; Traynor, Owen T.; Venkat, Arvind; Walker, Heather; Wallace, David J.; Guyette, Francis X

doi:10.1016/j.annemergmed.2018.05.018

Cited by 48 publications

(44 citation statements)

References 36 publications

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“…Data from 22 OHCA studies were included in the qualitative synthesis, with data from 17 observational studies included in meta-analysis. We described but did not include 5 studies in the meta-analysis: one randomised study since it presented only pilot feasibility data (33 patients, main trial is on-going) [30], three observational studies that only included patients who were discharged alive from hospital and reported long-term outcome data [31][32][33], and one study which examined the impact of a Post Arrest Consult Team on post cardiac arrest care processes and outcomes. [34] We found no studies reporting data for in-hospital cardiac arrest patients.…”

Section: Data Analysis and Synthesismentioning

confidence: 99%

“…Four studies was included in meta-analysis (one retrospective cohort study and one before and after study with adjusted analyses, and two retrospective cohort studies with unadjusted analyses) recruiting a total of 30,080 patients were included in meta-analysis. [30][31][32][33] In pooled data from two studies (n=3,673), care at a CAC was associated with increased likelihood of surviving to hospital discharge with favourable neurological outcome compared to other hospitals (OR 2.22 95% CI 1.74 to 2.84).…”

Section: Survival At 30 Days With Favourable Neurological Outcomes (Cmentioning

confidence: 99%

“…Survival to 30 days was reported in six studies (two retrospective cohort studies with adjusted analyses, one before and after study and three retrospective cohort studies with unadjusted analyses) recruiting a total of 45,066 patients. [33,35,37,[42][43][44] In pooled data from two studies (n=2,693) care at a CAC was associated with increased likelihood of survival to 30 days post admission (OR 2.14 95% CI 0.73 to 6.29). (Figure 4) There was considerable statistical heterogeneity (I 2 86%) and the certainty of evidence was assessed to be very low.…”

Section: Survival To 30 Days (Critical)mentioning

confidence: 99%

“…Eight studies [33,36,37,45,[48][49][50][51] reported outcomes in CAC versus non-CACs stratified by shockable or non-shockable rhythms. Data were too heterogeneous to allow for meta-analysis (Supplementary Materials Table 3).…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

“…The majority of the included studies compared OHCA patients who were directly transport to a CAC to those transported to a non-CAC. Only three studies examined outcomes in OHCA patients who were transferred to a CAC from a non-CAC [33,36,41]. In these studies, the proportion of patients with secondary transfers were small and, although two studies [33,41] adjusted for available confounders, there is potential for referral bias (whereby the sickest or those most likely to survive were transferred to CACs).…”

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

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Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

et al. 2019

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Please cite this article as: Yeung J, Matsuyama T, Bray J, Reynolds J, Skrifvars MB, Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? -A systematic review, Resuscitation (2019), https://doi.on behalf of the Education, Implementation and Team Task Force and Advanced Life Support Task Force of the International Liaison Committee on Resuscitation AIMTo perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' METHODSThe PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1 st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTSWe included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95%CI 0.68 to 12.48) and survival to 30 days (OR 2.14, 95%CI 0.73 to 6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95%CI 1.74 to 2.84) and survival to hospital discharge (OR 1.85, 95%CI 1.46 to 2.34). CONCLUSIONSVery low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.

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Section: Data Analysis and Synthesismentioning

confidence: 99%

Section: Survival At 30 Days With Favourable Neurological Outcomes (Cmentioning

confidence: 99%

Section: Survival To 30 Days (Critical)mentioning

confidence: 99%

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

Section: Subgroup Analyses and Sensitivity Analysesmentioning

confidence: 99%

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Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

et al. 2019

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Association of Initial Illness Severity and Outcomes After Cardiac Arrest With Targeted Temperature Management at 36 °C or 33 °C

et al. 2020

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IMPORTANCE It is uncertain what the optimal target temperature is for targeted temperature management (TTM) in patients who are comatose following cardiac arrest. OBJECTIVE To examine whether illness severity is associated with changes in the association between target temperature and patient outcome. DESIGN, SETTING, AND PARTICIPANTS This cohort study compared outcomes for 1319 patients who were comatose after cardiac arrest at a single center in Pittsburgh, Pennsylvania, from January 2010 to December 2018. Initial illness severity was based on coma and organ failure scores, presence of severe cerebral edema, and presence of highly malignant electroencephalogram (EEG) after resuscitation. EXPOSURE TTM at 36°C or 33°C. MAIN OUTCOMES AND MEASURES Primary outcome was survival to hospital discharge, and secondary outcomes were modified Rankin Scale and cerebral performance category. RESULTS Among 1319 patients, 728 (55.2%) had TTM at 33°C (451 [62.0%] men; median [interquartile range] age, 61 [50-72] years) and 591 (44.8%) had TTM at 36°C (353 [59.7%] men; median [interquartile range] age, 59 [48-69] years). Overall, 184 of 187 patients (98.4%) with severe cerebral edema died and 234 of 243 patients (96.3%) with highly malignant EEG died regardless of TTM strategy. Comparing TTM at 33°C with TTM at 36°C in 911 patients (69.1%) with neither severe cerebral edema nor highly malignant EEG, survival was lower in patients with mild to moderate coma and no shock (risk difference,-13.8%; 95% CI,-24.4% to-3.2%) but higher in patients with mild to moderate coma and cardiopulmonary failure (risk difference, 21.8%; 95% CI, 5.4% to 38.2%) or with severe coma (risk difference, 9.7%; 95% CI, 4.0% to 15.3%). Interactions were similar for functional outcomes. Most deaths (633 of 968 [65.4%]) resulted after withdrawal of life-sustaining therapies. CONCLUSIONS AND RELEVANCE In this study, TTM at 33°C was associated with better survival than TTM at 36°C among patients with the most severe post-cardiac arrest illness but without severe cerebral edema or malignant EEG. However, TTM at 36°C was associated with better survival among patients with mild-to moderate-severity illness.

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Cardiac arrest: clinical management

Rittenberger¹,

Mosesso²

2021

Emergency Medical Services

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Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers

Abstract: Both early interfacility transfer to a cardiac arrest receiving center and direct transport to a cardiac arrest receiving center from the scene are independently associated with reduced mortality.

Cited by 48 publications

References 36 publications

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? — A systematic review

Association of Initial Illness Severity and Outcomes After Cardiac Arrest With Targeted Temperature Management at 36 °C or 33 °C

Cardiac arrest: clinical management

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