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Cardiac arrest centers

Question Type:
Intervention
Full Question:
Adults and children in out-of-hospital cardiac arrest (OHCA) (P), does transport to a specialist cardiac arrest centre (I), compared with no directed transport (C), change neurologically intact survival at 30 days, survival to hospital discharge with good neurological outcome, survival to hospital discharge, hospital admission, ROSC (O)?
Consensus on Science:
There were no RCTs identified that specifically addressed this question. Of the 26 observational studies included in the evidence review, there was only 1 prospective study where survival outcomes in OHCA patients transported to a critical care medical center were compared with those transported to a non–critical care hospital.(Kajino 2010, 549) There were 10 observational studies that compared OHCA patient survival outcomes between hospitals based on various hospital characteristics such as hospital type, hospital size, hospital location, and OHCA case volume.(Engdahl 2000, 201; Herlitz 2006, 404; Carr 2009, 30; Kjaergaard 2009, 2169; Callaway 2010, 524; Stub 2011, 1489; Cudnik 2012, 862; Hansen 2013, 488; Callaway 2014, 657; Lee 2015, 31) Six observational studies compared OHCA patient survival outcomes before and after the implementation of a regionalized system of postresuscitation care.(Lund-Kordahl 2010, 422; Lick 2011, 26; Tagami 2012, 589; Bosson 2014, 217; Fothergill 2014, 96; Spaite 2014, 496) Six observational studies compared patient survival outcomes based on transport time to the hospital and/or direct versus indirect transport to a major center.(Davis 2007, 44; Spaite 2008, 61; Spaite 2009, 248; Mooney 2011, 206; Heffner 2012, 493; Kang 2014, 1301) One observational study compared OHCA patient outcomes across hospitals in those patients who received early coronary angiography or reperfusion and induced hypothermia versus those who did not.(Callaway 2014, 657) Two observational studies did not report any of the patient survival outcomes of interest and hence do not appear in the summary below.(Hartke 2010, 938; Martin-Gill 2011, 381) Heterogeneity in study design and inclusion criteria precluded meta-analyses. For the critical outcome of neurologically intact survival, we have identified very-low-quality evidence (downgraded for significant risk of bias and indirectness) from 12 observational studies enrolling more than 23 000 patients.(Kajino 2010, 549; Lund-Kordahl 2010, 422; Lick 2011, 26; Mooney 2011, 206; Cudnik 2012, 862; Heffner 2012, 493; Tagami 2012, 589; Bosson 2014, 217; Callaway 2014, 657; Kang 2014, 1301; Spaite 2014, 496; Lee 2015, 31) Three studies examined neurologic intact survival at 30 days.(Kajino 2010, 549; Tagami 2012, 589; Kang 2014, 1301) The other 9 studies reported survival to hospital discharge with good neurologic outcome.(Lund-Kordahl 2010, 422; Lick 2011, 26; Mooney 2011, 206; Cudnik 2012, 862; Heffner 2012, 493; Bosson 2014, 217; Callaway 2014, 657; Spaite 2014, 496; Lee 2015, 31) There was an association between improved neurologic intact survival and patient transport to specialist cardiac arrest centers. The key study reported improved 30-day neurologically favorable survival (Cerebral Performance Category ≤2) in OHCA patients transported to a critical care medical center compared with a non–critical care hospital (6.7% versus 2.8%; OR, 2.47; 95% CI, 2.02–3.01; P
Treatment Recommendation:
We suggest that OHCA patients should be considered for transport to a specialist cardiac arrest center as part of wider regional system of care for management of patients with OHCA (weak recommendation, low-quality evidence). Values, Preferences, and Task Force Insights In making this recommendation, we recognize the development of cardiac arrest centers may be considered as a health improvement initiative, as has been performed for other critical conditions, including myocardial infarction, stroke, and major trauma, without the evidence of randomized trials.
CoSTR Attachments:
EIT 624 Cardiac arrest centres_Data Collection Form_FINAL.xlsx    
EIT 624 Cardiac arrest centres_Grade Tables_FINAL.docx    
EIT 624 CoSTR_2May2015.docx    
EIT 624_Cardiac Arrest Centres_Summary of Bias Assessments_FINAL.xlsx    
EIT 624_Characteristics of included studies_FINAL.docx    
EIT 624_GRADE Recommendations.pdf    

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