Transport All Out-of-Hospital Cardiac Arrest Cases to Cath-Lab Centers: Danish Study

Fran Lowry

April 07, 2017

AARHUS, DENMARK — People who suffer an out-of-hospital cardiac arrest (OHCA) have a better chance of survival if they are transported directly to a center with a cardiac catheterization laboratory, regardless of distance, rather than simply to the nearest hospital, according to new research conducted in Denmark[1].

"Their chances are better if they are admitted directly for specialized postresuscitation care with coronary angiography and percutaneous coronary intervention, even if that center is farther away than a general hospital," Dr Tinne Tranberg (Aarhus University Hospital, Denmark) told heartwire from Medscape in an email.

Transport to a specialized center for coronary angiography and PCI improved chances of survival by 45%, according to a report published March 29, 2017 in the European Heart Journal with Tranberg as lead author.

"Therefore, we should continue to prioritize centralization with fewer high-volume invasive heart centers to which patients should be transported directly by emergency medical services, regardless of distance," said Tranberg.

"These procedures are most effective if carried out within 6 hours of the first call to emergency services, and more than 90% of coronary angiography and PCI in this study occurred within this time."

She and her team analyzed data from 41,186 patients throughout Denmark who had suffered an OHCA between 2001 and 2013. The patients were identified through the Danish Cardiac Arrest Registry.

A total of 15,822 patients (38%) were declared dead at the site of their event. Among the remaining patients, 17,991 were admitted to a local hospital and 7373 patients were admitted directly to an invasive heart center.

Their cumulative 30-day survival throughout the period was 9%, but 30-day survival had risen significantly from 5% in 2001 to 12% in 2013 (P<0.001); it rose from 3% to 10% during that time in the subset for whom there was no bystander cardiopulmonary resuscitation (CPR).

Bystander CPR itself became increasingly common over the years, rising from 18% of cases in 2001 to 60% in 2013 (P<0.001), and was significantly associated with reduced mortality (P=0.005).

The adjusted hazard ratio (HR) for mortality associated with admission directly to an invasive heart center was 0.91 (95% CI 0.89–0.93, P<0.001). The  HR for mortality associated with performing angiography with PCI was 0.33 (95% CI 0.25–0.45, P<0.001).

On the other hand, distance from the site of the event to the invasive heart center was not associated with lower mortality (P=0.70).

"Our results reflect that successful prehospital CPR is the key to survival, regardless of whether it is provided by a bystander or EMS, which should ideally be independent of the distance to the invasive center," the group writes.

They acknowledge that their study is not a randomized trial and can't imply cause and effect; still, their results "support the establishment of few high-volume invasive heart centers and suggest that OHCA patients should be field-triaged directly to these centers for optimal postresuscitation care, regardless of the distance."

The study was funded by the Danish Heart Foundation, the Savvaerksejer Foundation, and the Danish Cardiac Arrest Registry. The authors have declared no relevant financial relationships.

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