title: Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis.
abstract: Despite increasing evidence for specialized cardiac arrest centers, the impact of transport time on out-of-hospital cardiac arrest (OHCA) patients' outcome remains unclear. We systematically reviewed the prognostic impact of transport time in OHCA patients.
  
  
  
  We searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2016 for studies that had reported the relationship between transport time and outcome in OHCA patients. The primary outcome was survival at hospital discharge. The secondary outcomes included neurological outcome at hospital discharge and long-term outcome.
  
  
  
  From a total of 3454 titles retrieved from the literature search, 9 studies were included for final analysis. All nine studies (N=46,417) were retrospective observational studies. OHCA patients included were mostly male (61-76%), suffered a witnessed cardiac arrest in half of the cases, and had an initial shockable rhythm in one third of cases. The overall survival to hospital discharge for all cardiac rhythms was less than 6%. There was no evidence for a differential mortality risk in OHCA patients according to transport time (mean difference -0.05min [-0.86,0.76]; I225%; 4 studies, 2197 patients).
  
  
  
  Paramedic transport time was not associated with survival to hospital discharge or with neurological outcome at hospital discharge in adult OHCA patients. Future studies are needed to prospectively evaluate the prognostic impact of transport time particularly in rural settings and pediatric population.
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada. Electronic address: gerig@smh.ca.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Geri
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Joshua
authors.initials: J
authors.lastname: Gilgan
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Wen
authors.initials: W
authors.lastname: Wu
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Sandy
authors.initials: S
authors.lastname: Vijendira
authors.affiliation: Health Sciences Library, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Ziegler
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada; Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Ian R
authors.initials: IR
authors.lastname: Drennan
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Laurie
authors.initials: L
authors.lastname: Morrison
authors.affiliation: Rescu, Li Ka Shing Knowledge Institute at St Michael's Hospital, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
authors.forename: Steve
authors.initials: S
authors.lastname: Lin
mesh_terms: D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D064887:Observational Studies as Topic; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*
keywords: Meta-analysis; Out-of-hospital cardiac arrest; Outcome; Survival; Systematic review; Transport time