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

doi:10.1016/j.resuscitation.2018.04.039

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

Resuscitation. 2018 Jul:128:76-82. doi: 10.1016/j.resuscitation.2018.04.039. Epub 2018 May 2.

Authors

Nicole McKenzie¹, Teresa A Williams², Kwok M Ho³, Madoka Inoue⁴, Paul Bailey⁵, Antonio Celenza⁶, Daniel Fatovich⁷, Ian Jenkins⁸, Judith Finn⁹

Affiliations

¹ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia. Electronic address: nicole.mckenzie@curtin.edu.au.
² Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; Division of Emergency Medicine, University of Western Australia, Crawley, WA, Australia.
³ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Intensive Care Unit, Royal Perth Hospital, Perth, WA, Australia; School of Population Health, University of Western Australia, Crawley, WA, Australia.
⁴ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Ambulance Western Australia, Belmont, WA, Australia.
⁵ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; St John Ambulance Western Australia, Belmont, WA, Australia; St John of God Hospital, Murdoch, WA, Australia.
⁶ Division of Emergency Medicine, University of Western Australia, Crawley, WA, Australia; Sir Charles Gairdner Hospital, Nedlands, WA, Australia.
⁷ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Division of Emergency Medicine, University of Western Australia, Crawley, WA, Australia; Emergency Medicine, Royal Perth Hospital, Perth, WA, Australia.
⁸ Fremantle Hospital, Fremantle, WA, Australia.
⁹ Prehospital and Emergency Care Research Unit (PRECRU), Curtin University, Bentley, WA, Australia; Division of Emergency Medicine, University of Western Australia, Crawley, WA, Australia; St John Ambulance Western Australia, Belmont, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.

PMID: 29729284
DOI: 10.1016/j.resuscitation.2018.04.039

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.

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

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Cardiac Care Facilities / statistics & numerical data*
Cardiopulmonary Resuscitation / mortality*
Cardiopulmonary Resuscitation / statistics & numerical data
Female
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality*
Out-of-Hospital Cardiac Arrest / therapy
Outcome Assessment, Health Care
Percutaneous Coronary Intervention / mortality
Retrospective Studies
Survival Analysis
Time Factors
Time-to-Treatment
Transportation of Patients / statistics & numerical data*
Western Australia / epidemiology