Transportation to the hospital during an out-of-hospital cardiac arrest event was found to be associated with a lower probability of survival compared with continued on-scene resuscitation, according to a study published in JAMA.

Researchers prospectively analyzed consecutive nontraumatic adult out-of-hospital cardiac arrest data treated by emergency medical services (EMS) and collected from the Resuscitation Outcomes Consortium Cardiac Epidemiologic Registry. A total of 11,625 patients had intra-arrest transport, and 32,344 patients received continued on-scene resuscitation until termination of resuscitation or return of spontaneous circulation. The full propensity-matched cohort included 9406 patients treated with intra-arrest transport and 18,299 patients treated with on-scene resuscitation.

In this cohort, the overall median age was 67 years, 86% of cardiac arrests at a private location, and 49% were witnessed by a bystander or EMS.


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The survival-to-hospital-discharge rate was lower for patients who received intra-arrest transport vs on-scene resuscitation in the entire cohort (3.8% vs 12.6%, respectively; absolute difference, −8.8; 95% CI, −8.3 to −9.3). A similar trend was observed in the propensity-matched cohort, with survival to hospital discharge occurring in 4.0% of patients who received intra-arrest transport vs 8.5% of those who received on-scene resuscitation (absolute difference, 4.6%; 95% CI, 4.0-5.1).

A smaller percentage of patients who underwent intra-arrest transport vs on-scene resuscitation survived with a favorable neurological outcome in the propensity-matched cohort (2.9% vs 7.1%, respectively; absolute difference, 4.2%; 95% CI, 3.5-4.9).

Survival was greater in cardiac arrests witnessed by EMS for patients who received on-scene resuscitation vs intra-arrest transport (risk ratio, 0.58; 95% CI, 0.50-0.66; P =.001).

A limitation of this study was the lack of assessment for other patient and rescue personnel characteristics which could have influenced survival outcome.

 “These results do not support the practice of routinely transporting patients during resuscitation from out-of-hospital cardiac arrest to the hospital,” noted the study authors.

Reference

Grunau B, Kime N, Leroux B, et al. Association of intra-arrest transport vs continued on-scene resuscitation with survival to hospital discharge among patients with out-of-hospital cardiac arrest. JAMA. 2020;324(11):1058-1067. doi:10.1001/jama.2020.14185