Should EMS Drive Longer to Get to a Cardiac Center for Patients with Cardiac Arrest?

Patients who are successfully resuscitated after out of hospital cardiac arrest (OHCA) frequently require percutaneous coronary intervention (PCI), but emergency medical services (EMS) transfer time also predicts outcomes. So, should EMS choose a longer transport time to bring patients to a PCI center?

These authors used a registry of all OHCA in Montreal to compare outcomes according to transport times and type of center. EMS protocols at the time of the study (2010–2015) required that OHCA patients be transported to the nearest of the region's 20 hospitals, of which 7 were PCI centers.

Of nearly 5000 adult patients with OHCA who were transported to a hospital, 48% were transported to a PCI center and 52% to a non-PCI center. Patients transported to a PCI center had higher rates of prehospital return of spontaneous circulation and initially shockable rhythms. Survival to hospital discharge was significantly higher in patients transported to PCI centers (20% vs. 11%). Multivariable modeling suggested that a 14-minute increase in transport time would be offset by the benefits of transfer to a PCI center.