Impact of transport to critical care medical centers on outcomes after out-of-hospital cardiac arrest |
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Authors: | Kentaro Kajino Taku Iwami Tatsuya Nishiuchi Tetsuhisa Kitamura Tomohiko Sakai Atushi Hiraide Shigeru Yamayoshi |
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Affiliation: | a Emergency and Critical Care Medical Center, Osaka Police Hospital, Kitayama-cho, 10-31 Tennouji-ku, 543-0035 Osaka, Japan b Kyoto University, Health Services, Kyoto, Japan c Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States d Osaka Prefectural Senshu Critical Care Medical Center, Izumisano, Japan e Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Suita, Japan f Department of Traumatology and Acute Critical Medicine, Osaka University, Graduate School of Medicine, Suita, Japan g Center for Medical Education, Kyoto University Graduate School of Medicine, Kyoto, Japan |
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Abstract: | BackgroundPost-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.HypothesisOutcome after OHCA is better in patients transported to a CCMC compared a non-critical care hospital (NCCH).Materials and methodsAdults 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.Results10,383 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].ConclusionsSurvival 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. |
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Keywords: | Out-of-hospital cardiac arrest (OHCA) Cardiopulmonary resuscitation (CPR) Emergency medical services (EMS) Post-resuscitation care |
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