Effect of transport interval on out-of-hospital cardiac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers.
OBJECTIVE
To identify any association between out-of-hospital transport interval and survival to hospital discharge in victims of out-of-hospital cardiac arrest.


METHODS
Data from the Ontario Prehospital Advanced Life Support Study (January 1, 1991, to December 31, 2002), an Utstein-compliant registry of out-of-hospital cardiac arrest patients from 21 communities, were analyzed. Logistic regression identified factors that were independently associated with survival in consecutive adult, nontraumatic, out-of-hospital cardiac arrest patients and in the subgroup with return of spontaneous circulation.


RESULTS
A total of 18,987 patients met criteria and 15,559 (81.9%) had complete data for analysis (study group). Return of spontaneous circulation was achieved in 2,299 patients (14.8%), and 689 (4.4%) survived to hospital discharge. Median transport interval was 4.0 minutes (25th quartile 3.0 minutes; 75th quartile 6.2 minutes) for survivors and 4.2 minutes (25th quartile 3.0, 75th quartile 6.2) for nonsurvivors. Logistic regression revealed multiple factors that were independently associated with survival: witnessed arrest (odds ratio 2.61; 95% confidence interval [CI] 2.05 to 3.34), bystander cardiopulmonary resuscitation (odds ratio 2.22; 95% CI 1.82 to 2.70), initial rhythm of ventricular fibrillation/tachycardia (odds ratio 2.22; 95% CI 1.97 to 2.50), and shorter emergency medical services (EMS) response interval (odds ratio 1.26; 95% CI 1.20 to 1.33). There was no association between transport interval and survival in either the study group (odds ratio 1.01; 95% CI 0.99 to 1.05) or the return of spontaneous circulation subgroup (odds ratio 1.04; 95% CI 0.99, 1.08).


CONCLUSIONS
In a large out-of-hospital cardiac arrest study from demographically diverse EMS systems, longer transport interval was not associated with decreased survival. Given the growing evidence showing major influence from specialized postarrest care, these findings support conducting clinical trials that assess the effectiveness and safety of bypassing local hospitals to take patients to regional cardiac arrest centers.
Spaite
Daniel W
DW
Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, AZ.
Stiell
Ian G
IG
Bobrow
Bentley J
BJ
de Boer
Melanie
M
Maloney
Justin
J
Denninghoff
Kurt
K
Vadeboncoeur
Tyler F
TF
Dreyer
Jonathan
J
Wells
George A
GA
D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods* / Q000401:mortality; D003657:Decision Making; D004632:Emergency Medical Services / Q000592:standards*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D009864:Ontario / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D015996:Survival Rate; D013997:Time Factors; D014187:Transportation of Patients; D014218:Triage