1. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest
- Author
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James J. Menegazzi, Nancy Le, Brian Grunau, Dana Zive, Heather Herren, Laurie J. Morrison, Jim Christenson, Brian G. Leroux, Christian Vaillancourt, Gerald van Belle, Thomas D. Rea, Jonathan Elmer, Noah Kime, Michael Austin, Peter J. Kudenchuk, and Neal Richmond
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Resuscitation ,Return of spontaneous circulation ,01 natural sciences ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Interquartile range ,Modified Rankin Scale ,medicine ,Humans ,030212 general & internal medicine ,0101 mathematics ,Propensity Score ,Aged ,Original Investigation ,Aged, 80 and over ,business.industry ,010102 general mathematics ,Resuscitation Outcomes Consortium ,General Medicine ,Middle Aged ,Survival Analysis ,Cardiopulmonary Resuscitation ,Patient Discharge ,Advanced life support ,Transportation of Patients ,Cohort ,Emergency medicine ,Female ,Nervous System Diseases ,business ,Out-of-Hospital Cardiac Arrest ,Cohort study - Abstract
IMPORTANCE: There is wide variability among emergency medical systems (EMS) with respect to transport to hospital during out-of-hospital cardiac arrest (OHCA) resuscitative efforts. The benefit of intra-arrest transport during resuscitation compared with continued on-scene resuscitation is unclear. OBJECTIVE: To determine whether intra-arrest transport compared with continued on-scene resuscitation is associated with survival to hospital discharge among patients experiencing OHCA. DESIGN, SETTING, AND PARTICIPANTS: Cohort study of prospectively collected consecutive nontraumatic adult EMS-treated OHCA data from the Resuscitation Outcomes Consortium (ROC) Cardiac Epidemiologic Registry (enrollment, April 2011-June 2015 from 10 North American sites; follow-up until the date of hospital discharge or death [regardless of when either event occurred]). Patients treated with intra-arrest transport (exposed) were matched with patients in refractory arrest (at risk of intra-arrest transport) at that same time (unexposed), using a time-dependent propensity score. Subgroups categorized by initial cardiac rhythm and EMS-witnessed cardiac arrests were analyzed. EXPOSURES: Intra-arrest transport (transport initiated prior to return of spontaneous circulation), compared with continued on-scene resuscitation. MAIN OUTCOMES AND MEASURES: The primary outcome was survival to hospital discharge, and the secondary outcome was survival with favorable neurological outcome (modified Rankin scale
- Published
- 2020