A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: Implications for resuscitation centers☆☆☆
Received 16 September 2009; received in revised form 25 November 2009; accepted 16 December 2009. published online 01 February 2010.
Abstract
Objectives
National leaders have suggested that patients with an out of hospital cardiac arrest (OOHCA) may benefit from transport to specialized hospitals. We sought to assess the survival of OOHCA patients by transport distance and hospital proximity.
Methods
Prospective, cohort study of OOHCA patients in 11 Resuscitation Outcomes Consortium (ROC) sites across North America. Transport distance and hospital proximity was calculated using weighted centroid of census tract location by Geographic Information Systems (GIS). Patients were stratified into quartiles based on transport distance to the receiving hospital calculated via GIS. Descriptive statistics were used to describe characteristics by transport distance and to compare proximity to other hospitals. Multivariate logistic regression was used to evaluate the impact of transport distance on survival.
Results
26,628 patients were identified, 7540 (28%) were transported by EMS and included in the final analysis. The median transport time was 6.3min (IQR 5.4); the median transport distance being 2.4miles (3.9km). Most patients were taken to the closest hospital (71.7%; N=5412). However, unadjusted survival to discharge was lower for those taken to the closest compared to further hospitals (12.1% vs. 16.5%) despite similar patient characteristics. Transport distance was not associated with survival on logistic analysis (OR 1.00; 95% CI 0.99–1.01).
Conclusions
Survival to discharge was higher in OOHCA patients taken to hospitals located further than the closest hospital while transport distance was not associated with survival. This suggests that longer transport distance/time might not adversely affect outcome. Further studies are needed to inform policy decisions regarding best destination post-cardiac arrest.
aDepartment of Emergency Medicine, The Ohio State University Medical Center, Columbus, OH, United States
bClinical Trials Center, University of Washington, Seattle, WA, United States
cDepartment of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
dCenter for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States
eDepartment of Emergency Medicine, University of British Columbia, Vancouver, B.C., Canada
fDepartment of Emergency Medicine, University of California-San Diego, San Diego, CA, United States
Corresponding author at: 4510 Cramblett Medical Clinic Room 4510, 456 W 10th Avenue, Columbus, OH 43210, United States. Fax: +1 614 293 3124.
ABSTRACT