title: A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers.
abstract: OBJECTIVE
  National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity.
  
  
  METHODS
  Prospective, cohort study of OOHCA patients in 11 Resuscitation Outcomes Consortium (ROC) sites across North America. Transport distance and hospital proximity was calculated using weighted centroid of census tract location by Geographic Information Systems (GIS). Patients were stratified into quartiles based on transport distance to the receiving hospital calculated via GIS. Descriptive statistics were used to describe characteristics by transport distance and to compare proximity to other hospitals. Multivariate logistic regression was used to evaluate the impact of transport distance on survival.
  
  
  RESULTS
  26,628 patients were identified, 7540 (28%) were transported by EMS and included in the final analysis. The median transport time was 6.3 min (IQR 5.4); the median transport distance being 2.4 miles (3.9 km). Most patients were taken to the closest hospital (71.7%; N=5412). However, unadjusted survival to discharge was lower for those taken to the closest compared to further hospitals (12.1% vs. 16.5%) despite similar patient characteristics. Transport distance was not associated with survival on logistic analysis (OR 1.00; 95% CI 0.99-1.01).
  
  
  CONCLUSIONS
  Survival to discharge was higher in OOHCA patients taken to hospitals located further than the closest hospital while transport distance was not associated with survival. This suggests that longer transport distance/time might not adversely affect outcome. Further studies are needed to inform policy decisions regarding best destination post-cardiac arrest.
authors.affiliation: Department of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH, USA. mcudnik@hotmail.com
authors.forename: Michael T
authors.initials: MT
authors.lastname: Cudnik
authors.forename: Robert H
authors.initials: RH
authors.lastname: Schmicker
authors.forename: Christian
authors.initials: C
authors.lastname: Vaillancourt
authors.forename: Craig D
authors.initials: CD
authors.lastname: Newgard
authors.forename: James M
authors.initials: JM
authors.lastname: Christenson
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Davis
authors.forename: Robert A
authors.initials: RA
authors.lastname: Lowe
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D040362:Geographic Information Systems; D006297:Health Services Accessibility; D006323:Heart Arrest / Q000401:mortality* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D017063:Outcome Assessment, Health Care; D010351:Patient Discharge; D011446:Prospective Studies; D013997:Time Factors; D014186:Transportation / Q000706:statistics & numerical data*