title: Regionalisation of out-of-hospital cardiac arrest care for patients without prehospital return of spontaneous circulation.
abstract: OBJECTIVE
  The aim of this study was to evaluate the risk of prolonged transportation against the benefit of treatment in high-volume centres for out-of-hospital cardiac arrest (OHCA) patients without prehospital return of spontaneous circulation (ROSC).
  
  
  METHODS
  This study used a nationwide EMS-assessed OHCA database (2006-2008). Patients with cardiac aetiology were selected from the registry. A high-volume centre was defined as a hospital that received an average of more than 33 cases per year. OHCA patients without prehospital ROSC were divided into subgroups according to their destination (high-volume centre vs. low-volume centre) and transport interval. The rates of survival to discharge were compared among these groups using multivariate logistic regression analysis.
  
  
  RESULTS
  During the study period, 54,499 OHCA patients were assessed by EMS in Korea. Of these patients, prehospital resuscitation was attempted for 29,345 patients with presumed cardiac origin. After excluding cases with inappropriate time data, 27,662 cases were selected for further analysis. 15,885 (57.4%) patients were transported to low-volume centres while the rest were transported to high-volume centres. The rate of survival to discharge was 1.43% and 4.78%, respectively. A multivariate analysis indicated that even with a longer transport interval (TI)(TI 5-9 min vs. TI 0-4 min), the high-volume centres presented a better overall outcome.
  
  
  CONCLUSIONS
  A higher rate of survival to discharge was demonstrated when OHCA patients without prehospital ROSC were transported to high-volume rather than low-volume centres. The rate was still significantly higher when the transportation time was longer compared with that of low-volume centres.
authors.affiliation: Department of Emergency Medicine, Samsung Medical Center, Seoul, Republic of Korea. docchaster@gmail.com
authors.forename: Won Chul
authors.initials: WC
authors.lastname: Cha
authors.forename: Seung Chul
authors.initials: SC
authors.lastname: Lee
authors.forename: Sang Do
authors.initials: SD
authors.lastname: Shin
authors.forename: Kyoung Jun
authors.initials: KJ
authors.lastname: Song
authors.forename: Ae Jin
authors.initials: AJ
authors.lastname: Sung
authors.forename: Seung Sik
authors.initials: SS
authors.lastname: Hwang
mesh_terms: D000368:Aged; D001775:Blood Circulation; D015331:Cohort Studies; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data; D020127:Recovery of Function; D056910:Republic of Korea; D012189:Retrospective Studies; D013997:Time Factors