ABSTRACT
Background and
Objectives:
Direct transport to a
cardiac arrest centre following
out-of-hospital cardiac arrest may be associated with higher
survival. However, there is limited evidence available to support this within the
New Zealand context. This study used a
propensity score-matched cohort to investigate whether direct transport to a
cardiac arrest centre improved
survival in
New Zealand.
Methods:
A retrospective
cohort study was conducted using the Aotearoa
New Zealand Paramedic Care Collection (ANZPaCC) database for
adults treated for
out-of-hospital cardiac arrest of presumed cardiac aetiology between 1 July 2018 to 30 June 2023.
Propensity score-matched
analysis was used to investigate
survival at 30-days post-event according to the receiving
hospital being a
cardiac arrest centre versus a non-
cardiac arrest centre.
Results:
There were 2,297 OHCA
patients included. Propensity matching resulted in 554 matched pairs (n = 1108). Thirty-day
survival in
propensity score-matched
patients transported directly to a
cardiac arrest centre (56%) versus a non-
cardiac arrest centre (45%) was not significantly different (adjusted
Odds Ratio 0.78 95%CI 0.54, 1.13, p = 0.19). Shockable presenting rhythm, bystander
CPR, and presence of
STEMI were associated with a higher odds of 30 day
survival (p < 0.05).
Maori or Pacific Peoples
ethnicity and older age were associated with lower
survival (p < 0.05).
Conclusions:
This study found no statistically significant difference in outcomes for OHCA
patients transferred to a
cardiac arrest compared to a non-
cardiac arrest centre. However, the
odds ratio of 0.78, equivalent to a 22% decrease in 30-day
mortality, is consistent with benefit associated with management by a
cardiac arrest centre. Further
research in larger cohorts with detailed information on known outcome predictors, or large randomised clinical trials are needed.
