Emergency Medical Services
Background: The effects of direct transportation for patients with to out-of-hospital cardiac arrest (OHCA) a percutaneous coronary intervention (PCI) center on patient outcomes have been controversial. The aim of this study was to compare outcomes according to PCI performance levels of receiving hospitals and route of admission in patients with OHCA.
Methods: This nation-wide, cross-sectional study was conducted in South Korea between January 2015 and December 2016 using OHCA database of emergency medical services (EMS) treated patients with OHCA. We included patients who admitted to hospital among adults (≥18 years) with OHCA whose cause of OHCA were presumed of cardiac origin. The study patients were categorized into three groups according to the receiving hospital PCI performance level and route of admission: directly transported to a hospital with high PCI performance levels (HPCI) center (direct-HPCI group), directly transported to a hospital with low PCI performance levels (LPCI) center (direct-LPCI group) and inter-hospital transferred (IHT) from an LPCI center to an HPCI center (indirect-HPCI group). The outcome variables were survival to discharge and neurological recovery. The effects of the group of hospital on outcomes were assessed using multivariable logistic regression.
Results: A total of 6,296 patients were included in the final analysis, of whom 3,496 (55.5%) were classified as the direct-HPCI group, 2,103 (33.4%) as the direct-LPCI group, and 697 (11.1%) as the indirect-HPCI group. The adjusted odds ratio [aOR] of survival to discharge in direct-HPCI group was higher than that in direct-LPCI group (aOR = 0.67; 95% confidence interval [CI] 0.56–0.80], and was not differ from that in indirect-HPCI group (aOR = 1.17 [95% CI] 0.81–1.68). The direct-HPCI group was associated with a possible increased neurological recovery compared to direct-LPCI and indirect-HPCI group (aOR =0.65 [95% CI 0.48–0.87], and aOR =0.87 [95% CI 0.68–0.98]).
Conclusion:Direct and indirect transfer to a HPCI center is associated with a survival benefit. Benefit for neurological recovery in the indirect transfer to a hospital with HPCI center is attenuated. These findings have implications for EMS and IHT protocols for patients with OHCA.