Survival analysis in out-of-hospital cardiac arrest patients with shockable rhythm directly transport to Heart Centers

Abstract

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.

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

“…The κ value measuring interrater reliability was 0.75 when reviewing the title and abstracts and 0.9 for full‐text review. Finally, 36 studies 20 , 23 , 24 , 25 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 qualified for analysis. The study selection process and reasons for excluding the 54 studies are illustrated in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐P 2020 flow diagram (Figure 1 ).…”

“…A total of 147 943 patients were included in the 36 studies. Two studies 55 , 67 were conducted in Australia, 1 in Canada 66 , 1 in the Czech Republic, 60 2 in Denmark, 47 , 53 1 in France, 56 5 in Japan, 24 , 44 , 50 , 58 , 64 8 in South Korea, 40 , 42 , 46 , 48 , 49 , 51 , 62 , 63 1 in Norway, 37 4 in Taiwan, 23 , 45 , 65 , 68 2 in the United Kingdom, 20 , 59 and 9 § in the United States. Three articles reported data from the CARES (Cardiac Arrest Registry to Enhance Survival) registry, 2 articles from the CAVAS database (Cardiovascular Disease Surveillance), 2 articles from the NHIRD database (National Health Insurance Research), and 3 articles from the UOP (Utstein Osaka Project).…”

“…Seven studies 23 , 53 , 57 , 58 , 59 , 62 , 65 reported ORs for survival to 30 days or hospital discharge with good neurological outcome. Pooled analysis revealed a significantly higher survival with good neurological outcome among patients treated at CACs (OR, 2.27 [95% CI, 1.58–3.25]).…”

“…Subgroup analysis comparing patients with initial shockable or nonshockable rhythm (Figure 4 ) 23 , 25 , 44 , 50 , 65 revealed a significant increase in survival with good neurological outcome among patients with both shockable (OR, 2.31 [95% CI, 1.77–3.02]) and nonshockable rhythm (OR, 1.16 [95% CI, 0.73–1.84]) when treated at CACs. The treatment effect was significantly greater among patients with initial shockable compared with nonshockable rhythm ( P =0.006).…”

“…Seven studies 20 , 45 , 57 , 62 , 65 , 66 , 67 reported aORs for survival to 30 days or hospital discharge. Pooled analysis revealed a significant increase in survival among patients treated at CACs (aOR, 1.92 [95% CI, 1.59–2.32]; Figure 5 ).…”