The feasibility of a regional cardiac arrest receiving system

Davis, Daniel P.; Fisher, Roger; Aguilar, Steven; Metz, Marcelyn; Ochs, Ginger; McCallum-Brown, Lana; Ramanujam, Prasanthi; Buono, Colleen; Vilke, Gary M.; Chan, Theodore C.; Dunford, James V.

doi:10.1016/j.resuscitation.2006.11.009

Cited by 80 publications

(46 citation statements)

References 37 publications

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“…[3][4][5][6] Current studies focusing on the association between transport distance and outcomes are mainly limited to short drive times in urban settings, while current guidelines lack evidence supporting bypass, particularly in nonurban areas with longer transport distances. 5,6,[13][14][15][16] While transport to and care at regional cardiac centers have been shown to benefit STEMI patients, only indirect evidence exists that regional systems of care improve care and outcomes for OHCA patients. [5][6][7][8][9][10][11]25,26 We report data from a mixed urban-rural setting in North Carolina, in which a significant number of patients were transported over longer periods of time to arrive to a PCI center.…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] Nevertheless, evidence supporting bypassing the nearest non-PCI hospital to transport patients directly to a PCI center remains scarce and mostly limited to urban areas with short transport times. [13][14][15][16] Specifically, data on outcomes for patients who bypass a closer, local non-PCI hospital and who are transported for longer periods of time to arrive at specialized centers are warranted. 5,17 Therefore, using prehospital cardiac arrest data from mixed urban-rural areas in North Carolina, we examined the association between direct transport to a PCI center and discharge survival and neurological outcome among patients with prehospital return of spontaneous circulation (ROSC).…”

Section: Pci Center and Outcomes After Ohcamentioning

confidence: 99%

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Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Kragholm

Hansen

Dupre

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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O ut-of-hospital cardiac arrest (OHCA) is a major public healthcare issue affecting 200 000 to 400 000 Americans each year, with large variations in incidence, resuscitation practice, and outcomes between communities.1,2 Regional systems of care involving centralization of postresuscitation care have been proposed to improve outcomes because multiple organ systems can be affected after OHCA that likely are best treated at regional centers with percutaneous cardiac intervention (PCI) and critical care capabilities. [3][4][5][6] There is consensus that a regional cardiac arrest center at a minimum must have (1) a cardiac catheterization laboratory that is immediately accessible 24/7 and (2) the capability to provide targeted temperature management (TTM). Background-Practice guidelines recommend regional systems of care for out-of-hospital cardiac arrest. However, whether emergency medical services should bypass nonpercutaneous cardiac intervention (non-PCI) facilities and transport outof-hospital cardiac arrest patients directly to PCI centers despite longer transport time remains unknown. Methods and Results-Using the Cardiac Arrest Registry to Enhance Survival with geocoding of arrest location, we identified out-of-hospital cardiac arrest patients with prehospital return of spontaneous circulation and evaluated the association between direct transport to a PCI center and outcomes in North Carolina during 2012 to 2014. Destination hospital was classified according to PCI center status (catheterization laboratory immediately accessible 24/7). Inverse probability-weighted logistic regression accounting for age, sex, emergency medical services response time, clustering of county, transport time to nearest PCI center, initial heart rhythm, and prehospital ECG information was performed. Of 1507 patients with prehospital return of spontaneous circulation, 1359 (90.2%) were transported to PCI centers, of whom 873 (57.9%) bypassed the nearest non-PCI hospital and 148 (9.8%) were transported to non-PCI hospitals. Discharge survival was higher among those transported to PCI centers (33.5% versus 14.6%; adjusted odds ratio, 2.47; 95% confidence interval, 2.08-2.92). Compared with patients taken to non-PCI hospitals, odds of survival were higher for patients taken to the nearest hospital with PCI center status (odds ratio, 3.07; 95% confidence interval, 1.90-4.97) and for patients bypassing closer hospitals to PCI centers (odds ratio, 3.02; 95% confidence interval, 2.01-4.53). Adjusted survival remained significantly better across transport times of 1 to 5, 6 to 10, 11 to 20, 21 to 30, and >30 minutes. Conclusions-Direct transport to a PCI center is associated with better outcomes for out-of-hospital cardiac arrest patients, even when bypassing nearest hospital and regardless of transport time. (Circ Cardiovasc Qual Outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Pci Center and Outcomes After Ohcamentioning

confidence: 99%

Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Kragholm

Hansen

Dupre

et al. 2017

Circ: Cardiovascular Quality and Outcomes

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“…[171][172][173][174][175][176] One observational study compared OHCA patient outcomes across hospitals in those patients who received early coronary angiography or reperfusion and induced hypothermia versus those who did not. 156 Two observational studies did not report any of the patient survival outcomes of interest and hence do not appear in the summary below.…”

Section: October 20 2015mentioning

confidence: 99%

Part 8: Education, Implementation, and Teams

et al. 2015

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“…In a single urban American EMS system during the pre-hypothermia era, the median transport time was 7 (interquartile range, IQR 5, 11) minutes. (18) The duration of transport to hospital was not significantly associated with survival to hospital discharge after OOHCA. (18) In a multicenter observational study in Ontario during the pre-hypothermia era, the median transport interval was 4.2 (IQR, 3.0, 6.2) minutes.…”

Section: Transport Timementioning

confidence: 87%

“…(18) The duration of transport to hospital was not significantly associated with survival to hospital discharge after OOHCA. (18) In a multicenter observational study in Ontario during the pre-hypothermia era, the median transport interval was 4.2 (IQR, 3.0, 6.2) minutes. (19) Duration of transport was not significantly associated with survival.…”

Section: Transport Timementioning

confidence: 87%

Regional cardiac resuscitation systems of care

Nichol

2010

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The feasibility of a regional cardiac arrest receiving system

Cited by 80 publications

References 37 publications

Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Direct Transport to a Percutaneous Cardiac Intervention Center and Outcomes in Patients With Out-of-Hospital Cardiac Arrest

Part 8: Education, Implementation, and Teams

Regional cardiac resuscitation systems of care

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