Abstract 12497: Long Transport Distances to a Tertiary Cardiac Arrest Center Does Not Affect Survival in Patients With Out-of-Hospital Cardiac Arrest
Introduction: Patients with out-of-hospital cardiac arrest (OHCA) are increasingly transported to tertiary cardiac arrest centers, when the arrest is presumed to be of cardiac origin. For some patients, centralization has led to longer transport distances to advanced care resulting in prolonged prehospital system delays, which may affect outcome. Hypothesis: Longer transport distance to center for patients with OHCA reduces 30-day survival. Methods: Central Denmark Region covers rural and urban areas of 13 000 square kilometers and has a population of approximately 1.3 million inhabitants. Aarhus University Hospital functions as the tertiary cardiac care hospital with access to 24/7 cardiac catherization service and extracorporeal cardiopulmonary resuscitation. Distance to center varies greatly among citizens in the region; with longest distance exceeding 170 km. This observational retrospective study included all patients with OHCA referred to Aarhus University Hospital from 2015 to 2018. Kaplan-Meier curves were conducted to evaluate association between distance and mortality. The odds of 30-day mortality were generated using logistic regression. Results: A total of 807 patients with OHCA were referred to center. Distance to center was < 25km (22%), 25 to 50km (40%), 50 to 100km (20%) and > 100km (18%), respectively. The median prehospital system delay from collapse to arrival at center was 70 minutes [IQR, 55-90 minutes]. Logistic regression did not demonstrate an association between 30-day mortality and increasing distance to center (distance < 25 km as reference, 25 to 50km: OR 0.83, 95% CI [0.58-1.20], 50 to 100km: OR 0.96, 95% CI [0.62-1.47] and >100km: OR 1.20, 95% CI [0.77-1.88]). Conclusions: In OHCA patients with long transport distances to a tertiary cardiac center, survival was similar in patients with short distance to center. Centralization of post cardiac care is feasible in the setting of long transport distances.