Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study
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 in...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2024-06-01
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| Series: | Resuscitation Plus |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666520424000766 |
| _version_ | 1797219332093116416 |
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| author | Bridget Dicker Nick Garrett Graham Howie Aroha Brett Tony Scott Ralph Stewart Gavin D. Perkins Tony Smith Elena Garcia Verity F. Todd |
| author_facet | Bridget Dicker Nick Garrett Graham Howie Aroha Brett Tony Scott Ralph Stewart Gavin D. Perkins Tony Smith Elena Garcia Verity F. Todd |
| author_sort | Bridget Dicker |
| collection | DOAJ |
| description | 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 (n = 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, p = 0.19). Shockable presenting rhythm, bystander CPR, and presence of STEMI were associated with a higher odds of 30 day survival (p < 0.05). Māori or Pacific Peoples ethnicity and older age were associated with lower survival (p < 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. |
| first_indexed | 2024-04-24T12:31:57Z |
| format | Article |
| id | doaj.art-99b9bc8663644b1bb0bc36cbcf5cb6ab |
| institution | Directory Open Access Journal |
| issn | 2666-5204 |
| language | English |
| last_indexed | 2024-04-24T12:31:57Z |
| publishDate | 2024-06-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Resuscitation Plus |
| spelling | doaj.art-99b9bc8663644b1bb0bc36cbcf5cb6ab2024-04-08T04:08:41ZengElsevierResuscitation Plus2666-52042024-06-0118100625Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand studyBridget Dicker0Nick Garrett1Graham Howie2Aroha Brett3Tony Scott4Ralph Stewart5Gavin D. Perkins6Tony Smith7Elena Garcia8Verity F. Todd9Clinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand; Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New Zealand; Corresponding author at: St John New Zealand, 600 Great South Road, Mt Wellington, Auckland 1051, New Zealand.Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New ZealandClinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand; Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New ZealandClinical Audit and Research, Hato Hone St John New Zealand, Auckland, New ZealandCardiology Department, Northshore Hospital, Takapuna, Auckland, New ZealandTe Toka Tumai, Auckland City Hospital, Auckland, New ZealandWarwick Medical School, University of Warwick, Coventry CV4 7AL, United KingdomClinical Audit and Research, Hato Hone St John New Zealand, Auckland, New ZealandClinical Audit and Research, Hato Hone St John New Zealand, Auckland, New ZealandClinical Audit and Research, Hato Hone St John New Zealand, Auckland, New Zealand; Paramedicine Research Unit, Paramedicine Department, Auckland University of Technology, Auckland, New ZealandBackground 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 (n = 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, p = 0.19). Shockable presenting rhythm, bystander CPR, and presence of STEMI were associated with a higher odds of 30 day survival (p < 0.05). Māori or Pacific Peoples ethnicity and older age were associated with lower survival (p < 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.http://www.sciencedirect.com/science/article/pii/S2666520424000766Out of hospitalCardiac arrestResuscitationCardiac arrest centreParamedicEMS |
| spellingShingle | Bridget Dicker Nick Garrett Graham Howie Aroha Brett Tony Scott Ralph Stewart Gavin D. Perkins Tony Smith Elena Garcia Verity F. Todd Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study Resuscitation Plus Out of hospital Cardiac arrest Resuscitation Cardiac arrest centre Paramedic EMS |
| title | Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study |
| title_full | Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study |
| title_fullStr | Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study |
| title_full_unstemmed | Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study |
| title_short | Association between direct transport to a cardiac arrest centre and survival following out-of-hospital cardiac arrest: A propensity-matched Aotearoa New Zealand study |
| title_sort | association between direct transport to a cardiac arrest centre and survival following out of hospital cardiac arrest a propensity matched aotearoa new zealand study |
| topic | Out of hospital Cardiac arrest Resuscitation Cardiac arrest centre Paramedic EMS |
| url | http://www.sciencedirect.com/science/article/pii/S2666520424000766 |
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