TY - JOUR
T1 - Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest
AU - Kajino, Kentaro
AU - Iwami, Taku
AU - Daya, Mohamud
AU - Nishiuchi, Tatsuya
AU - Hayashi, Yasuyuki
AU - Kitamura, Tetsuhisa
AU - Irisawa, Taro
AU - Sakai, Tomohiko
AU - Kuwagata, Yasuyuki
AU - Hiraide, Atushi
AU - Kishi, Masashi
AU - Yamayoshi, Shigeru
N1 - Funding Information:
This study was supported by Grant-in-Aid for University and Society Collaboration, Grant-in-Aid for Scientific research from the Ministry of Education, Science, Sports, and Culture, Japan (No. 11794023, 19390459 ), and Health and Labor Science Research Grant for Cardiovascular Diseases ( H16-Shinkin-02 ), Comprehensive Research on Cardiovascular Diseases, and Research on Medical Safety and Health Technology Assessment from the Japanese Ministry of Health, Labor and Welfare .
PY - 2010/5
Y1 - 2010/5
N2 - Background: Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise. Hypothesis: Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH). Materials and methods: Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC. Results: 10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P<0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P<0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P=0.554]. Conclusions: Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.
AB - Background: Post-resuscitation care has emerged as an important predictor of survival from out-of-hospital cardiac arrest (OHCA). In Japan, selected hospitals are certified as Critical Care Medical Centers (CCMCs) based on their ability and expertise. Hypothesis: Outcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH). Materials and methods: Adults with OHCA of presumed cardiac etiology, treated by emergency medical services systems, and transported in Osaka from January 1, 2005 to December 31, 2007 were registered using a prospective Utstein style population cohort database. Primary outcome measure was 1 month neurologically favorable survival (CPC ≤ 2). Outcomes of patients transported to CCMC were compared with patients transported to NCCH using multiple logistic regressions and stratified on the basis of stratified field ROSC. Results: 10,383 cases were transported. Of these, 2881 were transported to CCMC and 7502 to NCCH. Neurologically favorable 1-month survival was greater in the CCMC group [6.7% versus 2.8%, P<0.001]. Among patients who were transported to hospital without field ROSC, neurologically favorable outcome was greater in the CCMC group than the NCCH group [1.7% versus 0.5%; adjusted odds ratio (OR), 3.39; 95% confidence interval (CI), 2.17-5.29; P<0.001]. In the presence of field ROSC, survival was similar between the groups [43% versus 41%; adjusted OR, 1.09; 95% CI, 0.82-1.45; P=0.554]. Conclusions: Survival after OHCA of presumed cardiac etiology transported to CCMCs was better than those transported to NCCHs. For OHCA patients without field ROSC, transport to a CCMC was an independent predictor for a good neurological outcome.
KW - Cardiopulmonary resuscitation (CPR)
KW - Emergency medical services (EMS)
KW - Out-of-hospital cardiac arrest (OHCA)
KW - Post-resuscitation care
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U2 - 10.1016/j.resuscitation.2010.02.008
DO - 10.1016/j.resuscitation.2010.02.008
M3 - Article
C2 - 20303640
AN - SCOPUS:77951663264
SN - 0300-9572
VL - 81
SP - 549
EP - 554
JO - Resuscitation
JF - Resuscitation
IS - 5
ER -