Receiving Hospital Characteristics Associated with Survival in Patients Transported by Emergency Medical Services After Out-of-Hospital Cardiac Arrest

Abstract

Objective

To test whether primary Emergency Medical Services (EMS) transport to hospitals with certain characteristics [24/7 percutaneous coronary intervention (PCI) availability, trauma center status, large (>24 bed) ICU] vs. hospitals without those characteristics is associated with improved hospital survival after Out-of-Hospital Cardiac Arrest (OHCA).

Methods

This is an analysis of a prospectively collected EMS database, which archives patients with OHCA treated by a single large metropolitan EMS system. The database contains Utstein data, EMS transport data, and survival to hospital discharge. EMS providers uniformly apply advanced cardiac life support protocols to OHCA patients in the field. Patients with ROSC are transported to one of 10 hospitals in the area. If ROSC is not achieved within 30 minutes, efforts are terminated and the patient is not transported. We used multivariate logistic regression to test if receiving hospital characteristics were independently associated with survival among those transported after ROSC. We excluded patients not transported to a hospital and patients with incomplete outcome data.

Results

Between January 2011 and December 2014, 1,188 OHCA patients were resuscitated in the field and transported to an area hospital. After excluding patients with missing data, 1,024 patients were included in the analysis. The average age was 61.1 years, and 57.7% were male. Of transported patients, 76% were taken to 24/7 PCI centers, 46% were taken to trauma centers, and 37% were taken to hospitals with large ICUs. There was considerable overlap in these hospital characteristics. A multivariate logistic regression model including age, gender, shockable rhythm, EMS time to scene, and dispatch complaint of cardiac arrest found that none of the hospital characteristics were independently associated with increased survival to discharge. The Odds Ratios (ORs) for survival were: PCI center: 1.28 (0.80 to 2.04); Trauma Center: 1.44 (0.73 to 2.85); and Large ICU: 1.39 (0.69 to 2.80).

Conclusions

After adjusting for patient demographic data, we found no significant independent association between receiving hospital characteristics and survival to discharge among OHCA patients transported after ROSC by a single EMS agency.

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