title: The feasibility of a regional cardiac arrest receiving system.
abstract: BACKGROUND
  Patients suffering out-of-hospital cardiac arrest (OOHCA) are generally transported to the closest ED, presumably to expedite a hospital level of care and improve the chances of return for spontaneous circulation (ROSC) or provide post-resuscitative care for patients with prehospital ROSC. As hospital-based therapies for survivors of OOHCA are identified, such as hypothermia and emergency primary coronary interventions (PCI), certain hospitals may be designated as cardiac arrest receiving facilities. The safety of bypassing non-designated facilities with such a regional system is not known.
  
  
  OBJECTIVE
  To explore the potential ED contribution in OOHCA victims without prehospital ROSC and document the relationship between transport time and outcome in patients with prehospital ROSC.
  
  
  METHODS
  This was a prospective, observational study conducted in a large, urban EMS system over an 18-month period. Data were collected using the Utstein template for OOHCA. The incidence of prehospital ROSC was calculated for patients who were declared dead on scene, transported but died in the ED, died in the hospital, and survived to hospital discharge. The relationship between transport time and survival was also explored for patients with prehospital ROSC.
  
  
  RESULTS
  A total of 1141 cardiac arrest patients were enrolled over the 18-month period. A strong association between prehospital ROSC and final disposition was observed (chi-square test for trend p<0.001). Only two patients who survived to hospital discharge did not have prehospital ROSC. Mean transport times were not significantly different for patients with prehospital ROSC who were declared dead in the ED (8.3min), died following hospital admission (7.8min), and survived to hospital discharge (8.5min). Outcomes in patients with prehospital ROSC who had shorter (7min or less) versus longer transport times were similar, and receiver-operator curve analysis indicated no predictive ability of transport time with regard to survival to hospital admission (area under the curve=0.52).
  
  
  CONCLUSIONS
  In this primarily urban EMS system, the vast majority of survivors from OOHCA are resuscitated in the field. A relationship between transport time and survival to hospital admission or discharge was not observed. This supports the feasibility of developing a regional cardiac arrest system with designated receiving facilities.
authors.affiliation: University of California San Diego, Department of Emergency Medicine, San Diego, CA 92103-8676, United States. davismd@cox.net
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Roger
authors.initials: R
authors.lastname: Fisher
authors.forename: Steven
authors.initials: S
authors.lastname: Aguilar
authors.forename: Marcelyn
authors.initials: M
authors.lastname: Metz
authors.forename: Ginger
authors.initials: G
authors.lastname: Ochs
authors.forename: Lana
authors.initials: L
authors.lastname: McCallum-Brown
authors.forename: Prasanthi
authors.initials: P
authors.lastname: Ramanujam
authors.forename: Colleen
authors.initials: C
authors.lastname: Buono
authors.forename: Gary M
authors.initials: GM
authors.lastname: Vilke
authors.forename: Theodore C
authors.initials: TC
authors.lastname: Chan
authors.forename: James V
authors.initials: JV
authors.lastname: Dunford
mesh_terms: D000368:Aged; D002140:California; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D012372:ROC Curve; D012041:Regional Medical Programs / Q000458:organization & administration*