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Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study. | LitMetric

AI Article Synopsis

  • The study aimed to determine if direct transport to a cardiac arrest center after an out-of-hospital cardiac arrest (OHCA) improved survival rates in New Zealand.
  • It analyzed data from 2,297 OHCA patients over five years, using propensity score matching, but found no significant difference in 30-day survival rates between those transported to cardiac arrest centers (56%) and non-cardiac centers (45%).
  • Factors like having a shockable rhythm and receiving bystander CPR increased survival odds, while older age and being of Māori or Pacific Peoples ethnicity were linked to lower survival. Further research is needed for more definitive results.

Article Abstract

Background And Objectives: Direct transport to a cardiac arrest centre following out-of-hospital cardiac arrest may be associated with higher survival. However, there is limited evidence available to support this within the New Zealand context. This study used a propensity score-matched cohort to investigate whether direct transport to a cardiac arrest centre improved survival in New Zealand.

Methods: A retrospective cohort study was conducted using the Aotearoa New Zealand Paramedic Care Collection (ANZPaCC) database for adults treated for out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 July 2018 to 30 June 2023. Propensity score-matched analysis was used to investigate survival at 30-days post-event according to the receiving hospital being a cardiac arrest centre versus a non-cardiac arrest centre.

Results: There were 2,297 OHCA patients included. Propensity matching resulted in 554 matched pairs ( = 1108). Thirty-day survival in propensity score-matched patients transported directly to a cardiac arrest centre (56%) versus a non-cardiac arrest centre (45%) was not significantly different (adjusted Odds Ratio 0.78 95%CI 0.54, 1.13,  = 0.19). Shockable presenting rhythm, bystander CPR, and presence of STEMI were associated with a higher odds of 30 day survival ( < 0.05). Māori or Pacific Peoples ethnicity and older age were associated with lower survival ( < 0.05).

Conclusions: This study found no statistically significant difference in outcomes for OHCA patients transferred to a cardiac arrest compared to a non-cardiac arrest centre. However, the odds ratio of 0.78, equivalent to a 22% decrease in 30-day mortality, is consistent with benefit associated with management by a cardiac arrest centre. Further research in larger cohorts with detailed information on known outcome predictors, or large randomised clinical trials are needed.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11004390PMC
http://dx.doi.org/10.1016/j.resplu.2024.100625DOI Listing

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