Direct transport to a PCI-capable hospital is associated with improved survival after adult out-of-hospital cardiac arrest of medical aetiology

Nicole McKenzie, Teresa A. Williams, Kwok M. Ho, Madoka Inoue, Paul Bailey, Antonio Celenza, Daniel Fatovich, Ian Jenkins, Judith Finn

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18 Citations (Scopus)

Abstract

Aim: To compare survival outcomes of adults with out-of-hospital cardiac arrest (OHCA) of medical aetiology directly transported to a percutaneous-coronary-intervention capable (PCI-capable) hospital (direct transport) with patients transferred to a PCI-capable hospital via another hospital without PCI services available (indirect transport) by emergency medical services (EMS). Methods: This retrospective cohort study used the St John Ambulance Western Australia OHCA Database and medical chart review. We included OHCA patients (≥18 years) admitted to any one of five PCI-capable hospitals in Perth between January 2012 and December 2015. Survival to hospital discharge (STHD) and survival up to 12-months after OHCA were compared between the direct and indirect transport groups using multivariable logistic and Cox-proportional hazards regression, respectively, while adjusting for so-called “Utstein variables” and other potential confounders. Results: Of the 509 included patients, 404 (79.4%) were directly transported to a PCI-capable hospital and 105 (20.6%) transferred via another hospital to a PCI-capable hospital; 274/509 (53.8%) patients STHD and 253/509 (49.7%) survived to 12-months after OHCA. Direct transport patients were twice as likely to STHD (adjusted odds ratio 1.97, 95% confidence interval [CI] 1.13–3.43) than those transferred via another hospital. Indirect transport was also associated with a possible increased risk of death, up to 12-months, compared to direct transport (adjusted hazard ratio 1.36, 95% CI 1.00–1.84). Conclusion: Direct transport to a PCI-capable hospital for post-resuscitation care is associated with a survival advantage for adults with OHCA of medical aetiology. This has implications for EMS transport protocols for patients with OHCA.

Original languageEnglish
Pages (from-to)76-82
Number of pages7
JournalResuscitation
Volume128
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Direct transport
  • Emergency medical services
  • Neurological outcome
  • Out-of-hospital cardiac arrest
  • Percutaneous-coronary-intervention
  • Post-resuscitation care
  • Survival

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