National Targeted Temperature Management Workgroup (Including:

). (2022) Impact of cardiac arrest centers on the survival of patients with nontraumatic out‐of‐hospital cardiac arrest : a systematic review and meta‐analysis. Journal of the American Heart Association, 11 (1). e023806. doi:10.1161/jaha.121.023806

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Abstract

Background
The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups.

Methods and Results
Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected.

Conclusions
Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine R Medicine > RC Internal medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
SWORD Depositor:	Library Publications Router
Library of Congress Subject Headings (LCSH):	Cardiac arrest -- Treatment, Cardiac resuscitation, Emergency medical services
Journal or Publication Title:	Journal of the American Heart Association
Publisher:	Ovid Technologies (Wolters Kluwer Health)
ISSN:	2047-9980
Official Date:	4 January 2022
Dates:	Date Event 4 January 2022 Published 20 December 2021 Available 9 November 2021 Accepted
Volume:	11
Number:	1
Article Number:	e023806
DOI:	10.1161/jaha.121.023806
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access
Copyright Holders:	Copyright © 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell
RIOXX Funder/Project Grant:	Project/Grant ID RIOXX Funder Name Funder ID Khoo Clinical Scholars Programme Khoo Teck Puat UK Foundation UNSPECIFIED KP/2019/0034 Khoo Pilot Award UNSPECIFIED UNSPECIFIED Duke-NUS Medical School https://www.duke-nus.edu.sg/ NMRC/CS_Seedfd/012/2018 National Medical Research Council http://dx.doi.org/10.13039/501100001349

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