title: Regional impact of cardiac arrest center criteria on out-of-hospital transportation practices.
abstract: BACKGROUND
  Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols have been associated with improved outcomes. Objectives. This study aimed 1) to identify the PCA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation and 2) to determine the proportion of PCA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria.
  
  
  METHODS
  We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PCA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, nontrauma cardiac arrest patients transported with a pulse from 2006 to 2008 for 16 EMS agencies. The proportions of patients transported to hospitals meeting three CAC criteria were compared: criteria A (availability of CATH and TH), criteria B (criteria A, >200 CATHs per year, and a PCA protocol), and criteria C (criteria B and a 24-hour intensivist).
  
  
  RESULTS
  Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met criteria A, seven (22.6%) met criteria B, and six (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded because of transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 patients (66.1%) transported to hospitals meeting criteria C.
  
  
  CONCLUSIONS
  In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH), but those facilities receive 81% of PCA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA. martingillc2@upmc.edu
authors.forename: Christian
authors.initials: C
authors.lastname: Martin-Gill
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Dilger
authors.forename: Francis X
authors.initials: FX
authors.lastname: Guyette
authors.forename: Jon C
authors.initials: JC
authors.lastname: Rittenberger
authors.forename: Clifton W
authors.initials: CW
authors.lastname: Callaway
mesh_terms: D000368:Aged; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data*; D004632:Emergency Medical Services / Q000379:methods*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D005843:Geography; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010360:Patient Transfer / Q000379:methods*; D010414:Pennsylvania; D012189:Retrospective Studies; D057566:Self Report