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

Kristian Kragholm; Carolina Malta Hansen; Matthew E Dupre; Ying Xian; Benjamin Strauss; Clark Tyson; Lisa Monk; Claire Corbett; Christopher B Fordyce; David A Pearson; Emil L Fosbøl; James G Jollis; Benjamin S Abella; Bryan McNally; Christopher B Granger

doi:10.1161/CIRCOUTCOMES.116.003414

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

Circ Cardiovasc Qual Outcomes. 2017 Jun;10(6):e003414. doi: 10.1161/CIRCOUTCOMES.116.003414.

Authors

Affiliations

¹ From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover Regional Medical Center, Wilmington, NC (C.C.); Division of Cardiology, University of British Columbia, Vancouver, Canada (C.B.F.); Carolinas Medical Center, Charlotte, NC (D.A.P.); The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia (B.S.A.); Emory University School of Medicine, Atlanta, GA (B.M.); and Rollins School of Public Health, Emory University, Atlanta, GA (B.M.). kristian.d.sorensen@dm.duke.edu.
² From the Duke Clinical Research Institute, Durham, NC (K.K., C.M.H., M.E.D., Y.X., C.T., L.M., C.B.F., E.L.F., J.G.J., C.B.G.); Departments of Cardiology and Epidemiology/Biostatistics, Aalborg University Hospital, Denmark (K.K.); Department of Community and Family Medicine (M.E.D.), Nicholas School of the Environment (B.S.), Duke University, Durham, NC; Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.); Center for Educational Excellence, Durham, NC (C.T.); New Hanover Regional Medical Center, Wilmington, NC (C.C.); Division of Cardiology, University of British Columbia, Vancouver, Canada (C.B.F.); Carolinas Medical Center, Charlotte, NC (D.A.P.); The Heart Center, University Hospital of Copenhagen, Rigshospitalet, Denmark (E.L.F.); Center for Resuscitation Science, Department of Emergency Medicine, University of Pennsylvania, Philadelphia (B.S.A.); Emory University School of Medicine, Atlanta, GA (B.M.); and Rollins School of Public Health, Emory University, Atlanta, GA (B.M.).

PMID: 28615177
DOI: 10.1161/CIRCOUTCOMES.116.003414

Abstract

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 out-of-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.

Keywords: cardiopulmonary resuscitation; emergency medical services; out-of-hospital cardiac arrest; post-resuscitation care; regional systems of care.

Publication types

Observational Study

MeSH terms

Aged
Cardiopulmonary Resuscitation* / adverse effects
Cardiopulmonary Resuscitation* / mortality
Chi-Square Distribution
Coronary Angiography
Delivery of Health Care, Integrated*
Electrocardiography
Emergency Medical Services*
Female
Hospital Mortality
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
North Carolina
Odds Ratio
Out-of-Hospital Cardiac Arrest / diagnosis
Out-of-Hospital Cardiac Arrest / mortality
Out-of-Hospital Cardiac Arrest / therapy*
Patient Discharge
Percutaneous Coronary Intervention* / adverse effects
Percutaneous Coronary Intervention* / mortality
Registries
Risk Assessment
Risk Factors
Time Factors
Time-to-Treatment
Transportation of Patients*
Treatment Outcome