title: A multicentre observational study of inter-hospital transfer for post-resuscitation care after out-of-hospital cardiac arrest.
abstract: To provide therapeutic hypothermia (TH) to survivors after out-of-hospital cardiac arrest (OHCA), inter-hospital transfers (IHT) are frequently required. The safety of IHT remains controversial. The aim of this study was to investigate whether the effect of TH on brain recovery after OHCA differs between IHT and direct arrival groups.
  
  
  
  We identified patients with OHCA of presumed cardiac aetiology who were resuscitated by emergency medical services and experienced return-of-spontaneous circulation in 27 hospitals between January and December 2014. The main exposure variables were TH and IHT. The primary endpoint was discharge with good neurological recovery. We compared outcomes between the TH and non-TH groups using multivariable logistic regression with an interaction term between TH and IHT, after adjusting for potential confounders.
  
  
  
  Among 1616 patients, 576 patients were included in the final analyses. Neurologic recovery was better in the TH group (46.2%) than in the non-TH group (20.1%) (adjusted odds ratio [aOR] 2.03 [95% confidence interval (CI) 1.24-3.33]). In the interaction model for the outcome of good neurological recovery, the aOR for TH was 2.82 (95% CI 1.59-5.01) in the direct transfer group vs. 0.76 (95% CI 0.29-2.01) in the IHT group. The measure of interaction on the multiplicative scale in this model was also statistically significant (OR 0.27 [95% CI 0.07-0.83]; p=0.02).
  
  
  
  IHT modified the effect of TH on neurological recovery for survivors of OHCA. TH is significantly less beneficial for good neurological recovery in patients who arrive via IHT than for those who arrive directly.
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, South Korea.
authors: Jeong Ho
authors: JH
authors: Park
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea. Electronic address: arendt75@gmail.com.
authors: Ki Ok
authors: KO
authors: Ahn
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea.
authors: Sang Do
authors: SD
authors: Shin
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea.
authors: Kyoung Jun
authors: KJ
authors: Song
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea.
authors: Young Sun
authors: YS
authors: Ro
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do, South Korea.
authors: Joo Yeong
authors: JY
authors: Kim
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea.
authors: Eui Jung
authors: EJ
authors: Lee
authors: Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 101 Daehak-Ro, Jongno-Gu, Seoul 110-744, South Korea; Department of Emergency Medicine, National Medical Center, 245 Eulji-ro, Jung-gu, Seoul, South Korea.
authors: Yu Jin
authors: YJ
authors: Lee
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D016022:Case-Control Studies; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D058687:Out-of-Hospital Cardiac Arrest / Q000628:therapy*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011446:Prospective Studies; D020127:Recovery of Function; D018709:Statistics, Nonparametric; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Hypothermia; Induced; Out-of-hospital cardiac arrest; Outcomes; Patient transfer