Direct transfer to resuscitation center doubles odds of OHCA survival

People who experience out-of-hospital cardiac arrest (OHCA) are nearly twice as likely to survive if they are transferred directly to a hospital with 24-hour capability to perform PCI or targeted temperature management (TTM) versus another center, according to a meta-analysis published Nov. 28 in the Journal of the American Heart Association.

The authors classified these PCI- and TTM-capable facilities as cardiac resuscitation centers. They said the American Heart Association has previously proposed a regionalized approach to OHCA where these hospitals accept more patients—similar to what is used in ST-segment elevation myocardial infarction care—but few such networks have been established. Instead, patients are often transferred to the closest hospital, regardless of the specialized treatments it offers.

To quantify the possible benefit of direct transport to a cardiac resuscitation center, senior author Alexis Cournoyer, MD, and colleagues pooled 10 nonrandomized, observational studies encompassing 61,240 patients.

In the eight studies that tracked survival to hospital discharge, transport to a cardiac resuscitation center was associated with 1.93-fold odds of survival. In the other two studies, direct transfer to a PCI- and TTM-capable facility was linked to a 2.35-fold increase in 30-day survival.

Eight studies including almost 90,000 patients also analyzed survival with a good neurologic outcome, defined as a Cerebral Performance Category of 1 or 2. Similar to the overall survival results, that outcome was nearly twice as likely (odds ratio: 1.84) in patients sent to cardiac resuscitation hospitals.

“When possible, it is reasonable to transport patients suffering from an out‐of‐hospital cardiac arrest directly to a cardiac resuscitation center,” Cournoyer et al. wrote.A bypass delay of up to 15 minutes for patients not having experienced prehospital return of spontaneous circulation and of 30 minutes for patients having experienced prehospital return of spontaneous circulation is probably safe. This should be further tested in a prospective study.”

The researchers assigned transport to a cardiac resuscitation center a class IIa recommendation, based on B-level, nonrandomized evidence. They said the benefit of sending patients to such centers likely stems from the fact that both PCI and TTM have proven helpful in treating OHCA.

“Most nontraumatic OHCA results from an acute coronary syndrome, and PCI is the preferred therapeutic procedure for that pathology,” Cournoyer and coauthors wrote. “Patients remaining comatose following an OHCA also strongly benefit from some form of TTM. … Having on‐site access to this treatment all of the time increases the odds of providing this emergent intervention to patients.”

Another potential explanation for the better outcomes, the authors noted, is that many resuscitation centers are large academic medical hospitals with experienced staff who are more accustomed to treating severe disease.

Cournoyer et al. said further research is needed to clarify how long of a bypass time is acceptable for OHCA patients, particularly if they don’t experience a return of spontaneous circulation before hospital arrival.