Title: Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest<br/>Author: Lindsay Ritter<br/><a href='http://umem.org/profiles/alumni/1731/'>[Click to email author]</a><hr/><p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">Historically, there has been debate on transporting outside hospital cardiac arrests, as well a trauma, with the question of whether to "scoop and run" or "stay and play". </span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">Could hasty transportation of cardiac arrest patients put a damper on resuscitation quality? </span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">A recent propensity-matched study in JAMA analyzed 192 EMS agencies across 10 N American sites.</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><strong>Methods:</strong></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry, which counted 43,969 consecutive cases of nontraumatic adult EMS-treated OHCA (median age 67, 37% of whom were women) in 2011-2015.</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-25% of these patients were transported to the hospital</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Matched 1:1 with patients in refractory arrest who were resuscitated on scene </span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Primary outcome was survival to hospital discharge, secondary outcome survival to hospital discharge with a favorable neurological status </span></span></p> <p> </p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><strong>Results:</strong></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Duration of out-of-hospital resuscitation was only 6 minutes longer in the intra-arrest transport group (29.1 and 22.9 minutes; not a statistically significant difference)</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Survival to hospital discharge was <span guardian="" helvetica="" textsans="">3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation</span></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><span guardian="" helvetica="" textsans="">-In the propensity-matched cohort, which included 27,705 patients, survival to hospital discharge occurred in 4.0% of patients who underwent intra-arrest transport vs 8.5% who received on-scene resuscitation (risk difference, 4.6% [95% CI, 4.0- 5.1])</span></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><span guardian="" helvetica="" textsans="">-Favorable neurological outcome occurred in 2.9% of patients who underwent intra-arrest transport vs 7.1% who received on-scene resuscitation (risk difference, 4.2% [95% CI, 3.5%-4.9%])</span></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Intra-arrest transport during resuscitation was associated with worse odds of survival to hospital discharge compared to on-scene resuscitation (4% vs 8.5%, RR 0.48, CI 0.43-0.54)</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Findings persisted across subgroups of initial shockable rhythm vs. non-shockable rhythms (most common initial rhythm was aystole), as well as EMS witness arrests vs. unwitnessed arrests </span></span></p> <p> </p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><strong>Conclusion:</strong></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-This study does not support the routine transportation of patients in cardiac arrest during rescuscitation.</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-The neurologically intact survival benefit associated with on-scene resuscitation is both impressive and intriguing.</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-However, what implications could this have on ECPR? </span></span></p> <p> </p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;"><strong>Limitations:</strong></span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Potential bias due to observational nature of study </span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Duration of resuscitations very similar, unknown exactly how long transport times were or if this was in urban or rural populations</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-External validity not generalizable due to heterogeneity of patient populations and EMS systems</span></span></p> <p> <span style="font-size:14px;"><span style="font-family:times new roman,times,serif;">-Further randomized clinical trials are required</span></span></p>
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<fieldset><legend>References</legend>
<p> <span font-size:="" guardian="" helvetica="" style="color: rgb(51, 51, 51); font-family: " textsans="">Grunau B, Kime N, Leroux B, et al. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. </span><em font-size:="" guardian="" helvetica="" style="box-sizing: inherit; color: rgb(51, 51, 51); font-family: " textsans="">JAMA.</em><span font-size:="" guardian="" helvetica="" style="color: rgb(51, 51, 51); font-family: " textsans=""> 2020;324(11):1058–1067. doi:10.1001/jama.2020.14185</span></p> </fieldset>