Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest

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....

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2020-09, Vol.324 (11), p.1058-1067
Main Authors: Grunau, Brian, Kime, Noah, Leroux, Brian, Rea, Thomas, Van Belle, Gerald, Menegazzi, James J, Kudenchuk, Peter J, Vaillancourt, Christian, Morrison, Laurie J, Elmer, Jonathan, Zive, Dana M, Le, Nancy M, Austin, Michael, Richmond, Neal J, Herren, Heather, Christenson, Jim
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Cardiac arrest
Cardiopulmonary Resuscitation - methods
Cohort Studies
Consortia
Emergency Medical Services
Epidemiology
Female
Heart
Humans
Male
Middle Aged
Nervous System Diseases - etiology
Original Investigation
Out-of-Hospital Cardiac Arrest - complications
Out-of-Hospital Cardiac Arrest - mortality
Out-of-Hospital Cardiac Arrest - therapy
Patient Discharge
Patients
Propensity Score
Resuscitation
Risk
Subgroups
Survival
Survival Analysis
Time dependence
Transportation of Patients
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Summary: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
ISSN:0098-7484
1538-3598
DOI:10.1001/jama.2020.14185