scholarly journals Simultaneous external validation of various cardiac arrest prognostic scores: a single-center retrospective study

2021 ◽  
Vol 29 (1) ◽  
Author(s):  
Takumi Tsuchida ◽  
Kota Ono ◽  
Kunihiko Maekawa ◽  
Takeshi Wada ◽  
Kenichi Katabami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Roc Curve ◽  
External Validation ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Prognostic Scores ◽  
Low Flow ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
End Stage

Abstract Background This study aimed to compare and validate the out-of-hospital cardiac arrest (OHCA); cardiac arrest hospital prognosis (CAHP); non-shockable rhythm, unwitnessed arrest, long no-flow or long low-flow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause (NULL-PLEASE) clinical; post-cardiac arrest syndrome for therapeutic hypothermia (CAST); and revised CAST (rCAST) scores in OHCA patients treated with recent cardiopulmonary resuscitation strategies. Methods We retrospectively collected data on adult OHCA patients admitted to our emergency department between February 2015 and July 2018. OHCA, CAHP, NULL-PLEASE clinical, CAST, and rCAST scores were calculated based on the data collected. The predictive abilities of each score were tested using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve. Results We identified 236 OHCA patients from computer-based medical records and analyzed 189 without missing data. In OHCA patients without bystander witnesses, CAHP and OHCA scores were not calculated. Although the predictive abilities of the scores were not significantly different, the NULL-PLEASE score had a large AUC of ROC curve in various OHCA patients. Furthermore, in patients with bystander-witnessed OHCA, the NULL-PLEASE score had large partial AUCs of ROC from sensitivity 0.8–1.0 and specificity 0.8–1.0. Conclusions The NULL-PLEASE score had a high, comprehensive predictive ability in various OHCA patients. Furthermore, the NULL-PLEASE score had a high predictive ability for good and poor neurological outcomes in patients with bystander-witnessed OHCA.

scholarly journals Simultaneous External Validation of Various Cardiac Arrest Prognostic Scores: a Single-center Retrospective Study

2021 ◽  
Author(s):  
Takumi Tsuchida ◽  
Kota Ono ◽  
Kunihiko Maekawa ◽  
Takeshi Wada ◽  
Kenichi Katabami ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
External Validation ◽  
Area Under The Curve ◽  
Predictive Ability ◽  
Prognostic Scores ◽  
Low Flow ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Computer Based ◽  
End Stage

Abstract Background: This study aimed to compare and validate the out-of-hospital cardiac arrest (OHCA); cardiac arrest hospital prognosis (CAHP); non-shockable rhythm, unwitnessed arrest, long no-flow or long low-flow period, blood pH < 7.2, lactate > 7.0 mmol/L, end-stage chronic kidney disease, age ≥ 85 years, still resuscitation, and extracardiac cause (NULL-PLEASE) clinical; post-cardiac arrest syndrome for therapeutic hypothermia (CAST); and revised CAST (rCAST) scores in OHCA patients treated with recent cardiopulmonary resuscitation strategies.Methods: We retrospectively collected data on adult OHCA patients admitted to our emergency department between February 2015 and July 2018. OHCA, CAHP, NULL-PLEASE clinical, CAST, and rCAST scores were calculated based on the data collected. The predictive abilities of each score were tested using the area under the curve (AUC) of the receiver operating characteristic (ROC) curve.Results: We identified 236 OHCA patients from computer-based medical records and analyzed 189 without missing data. In OHCA patients without bystander witnesses, CAHP and OHCA scores were not calculated. Although the predictive abilities of the scores were not significantly different, the NULL-PLEASE score had a large AUC of ROC curve in various OHCA patients. Furthermore, in patients with bystander-witnessed OHCA, the NULL-PLEASE score had large partial AUCs of ROC from sensitivity 0.8 to 1.0 and specificity 0.8 to 1.0. Conclusions: The NULL-PLEASE score had a high, comprehensive predictive ability in various OHCA patients. Furthermore, the NULL-PLEASE score had a high predictive ability for good and poor neurological outcomes in patients with bystander-witnessed OHCA.

Risk of Conversion to Arthroplasty After Hip Arthroscopy: Validation of a Published Risk Score Using an Independent, Prospectively Collected Database

2021 ◽  
pp. 036354652199382
Author(s):  
Mario Hevesi ◽  
Devin P. Leland ◽  
Philip J. Rosinsky ◽  
Ajay C. Lall ◽  
Benjamin G. Domb ◽  
...  
Keyword(s):  
Risk Score ◽  
Roc Curve ◽  
Hip Arthroscopy ◽  
External Validation ◽  
Area Under The Curve ◽  
Harris Hip Score ◽  
Brier Score ◽  
Level Of Evidence ◽  
Center Edge ◽  
Modified Harris Hip Score

Background: Hip arthroscopy is rapidly advancing and increasingly commonly performed. The most common surgery after arthroscopy is total hip arthroplasty (THA), which unfortunately occurs within 2 years of arthroscopy in up to 10% of patients. Predictive models for conversion to THA, such as that proposed by Redmond et al, have potentially substantial value in perioperative counseling and decreasing early arthroscopy failures; however, these models need to be externally validated to demonstrate broad applicability. Purpose: To utilize an independent, prospectively collected database to externally validate a previously published risk calculator by determining its accuracy in predicting conversion of hip arthroscopy to THA at a minimum 2-year follow-up. Study Design: Cohort study (diagnosis); Level of evidence, 1. Methods: Hip arthroscopies performed at a single center between November 2015 and March 2017 were reviewed. Patients were assessed pre- and intraoperatively for components of the THA risk score studied—namely, age, modified Harris Hip Score, lateral center-edge angle, revision procedure, femoral version, and femoral and acetabular Outerbridge scores—and followed for a minimum of 2 years. Conversion to THA was determined along with the risk score’s receiver operating characteristic (ROC) curve and Brier score calibration characteristics. Results: A total of 187 patients (43 men, 144 women, mean age, 36.0 ± 12.4 years) underwent hip arthroscopy and were followed for a mean of 2.9 ± 0.85 years (range, 2.0-5.5 years), with 13 patients (7%) converting to THA at a mean of 1.6 ± 0.9 years. Patients who converted to THA had a mean predicted arthroplasty risk of 22.6% ± 12.0%, compared with patients who remained arthroplasty-free with a predicted risk of 4.6% ± 5.3% ( P < .01). The Brier score for the calculator was 0.04 ( P = .53), which was not statistically different from ideal calibration, and the calculator demonstrated a satisfactory area under the curve of 0.894 ( P < .001). Conclusion: This external validation study supported our hypothesis in that the THA risk score described by Redmond et al was found to accurately predict which patients undergoing hip arthroscopy were at risk for converting to subsequent arthroplasty, with satisfactory discriminatory, ROC curve, and Brier score calibration characteristics. These findings are important in that they provide surgeons with validated tools to identify the patients at greatest risk for failure after hip arthroscopy and assist in perioperative counseling and decision making.

scholarly journals Impact of cooling method on the outcome of initial shockable or non-shockable out of hospital cardiac arrest patients receiving target temperature management: a nationwide multicentre cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Makoto Watanabe ◽  
Tasuku Matsuyama ◽  
Hikaru Oe ◽  
Makoto Sasaki ◽  
Yuki Nakamura ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Propensity Score Analysis ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Multivariable Logistic Regression Analysis ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Score Analysis ◽  
Hospital Cardiac Arrest ◽  
Cooling Methods

Abstract Background Little is known about the effectiveness of surface cooling (SC) and endovascular cooling (EC) on the outcome of out-of-hospital cardiac arrest (OHCA) patients receiving target temperature management (TTM) according to their initial rhythm. Methods We retrospectively analysed data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest registry, a multicentre, prospective nationwide database in Japan. For our analysis, OHCA patients aged ≥ 18 years who were treated with TTM between June 2014 and December 2017 were included. The primary outcome was 30-day survival with favourable neurological outcome defined as a Glasgow–Pittsburgh cerebral performance category score of 1 or 2. Cooling methods were divided into the following groups: SC (ice packs, fans, air blankets, and surface gel pads) and EC (endovascular catheters and any dialysis technique). We investigated the efficacy of the two categories of cooling methods in two different patient groups divided according to their initially documented rhythm at the scene (shockable or non-shockable) using multivariable logistic regression analysis and propensity score analysis with inverse probability weighting (IPW). Results In the final analysis, 1082 patients were included. Of these, 513 (47.4%) had an initial shockable rhythm and 569 (52.6%) had an initial non-shockable rhythm. The proportion of patients with favourable neurological outcomes in SC and EC was 59.9% vs. 58.3% (264/441 vs. 42/72), and 11.8% (58/490) vs. 21.5% (17/79) in the initial shockable patients and the initial non-shockable patients, respectively. In the multivariable logistic regression analysis, differences between the two cooling methods were not observed among the initial shockable patients (adjusted odd ratio [AOR] 1.51, 95% CI 0.76–3.03), while EC was associated with better neurological outcome among the initial non-shockable patients (AOR 2.21, 95% CI 1.19–4.11). This association was constant in propensity score analysis with IPW (OR 1.40, 95% CI 0.83–2.36; OR 1.87, 95% CI 1.01–3.47 among the initial shockable and non-shockable patients, respectively). Conclusion We suggested that the use of EC was associated with better neurological outcomes in OHCA patients with initial non-shockable rhythm, but not in those with initial shockable rhythm. A TTM implementation strategy based on initial rhythm may be important.

Abstract 210: Effects of Indication for Veno-Arterial Extracorporeal Membrane Oxygenation on Predictive Value of Save Score

Circulation ◽  
2019 ◽  
Vol 140 (Suppl_2) ◽  
Author(s):  
Marinos Kosmopoulos ◽  
Jason A Bartos ◽  
Demetris Yannopoulos
Keyword(s):  
Extracorporeal Membrane Oxygenation ◽  
Roc Curve ◽  
Predictive Value ◽  
Prediction Models ◽  
External Validation ◽  
Area Under The Curve ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Membrane Oxygenation ◽  
Survival Estimation ◽  
Va Ecmo

Introduction: Veno-Arterial Extracorporeal Membrane Oxygenation (VA ECMO) has emerged as a prominent tool for management of patients with Inability to Wean Off Cardiopulmonary Bypass (IWOCB), extracorporeal cardiopulmonary resuscitation (eCPR) or refractory cardiogenic shock (RCS). The high mortality that is still associated with these diseases urges for the development of reliable prediction models for mortality after cannulation. Survival After VA ECMO (SAVE) Score consists one of the most widely used prediction tools and the only model with external validation. However, its predictive value is still under debate. Hypothesis: Whether VA ECMO indication affects the predictive value of SAVE Score. Methods: 317 patients treated with VA ECMO in a quaternary center (n= 52 for IWOCB, n=179 for eCPR and n=86 for RCS) were retrospectively assessed for differences in SAVE Score and their primary outcomes. The Receiver Operating Characteristic (ROC) curve for SAVE Score and mortality was calculated separately for each VA ECMO indication. Results: The three groups had significant differences in SAVE Score (p<0.01) without significant differences in mortality (p=0.176). ROC Curve calculation indicated significant differences in predictive value of SAVE Score for survival among its different indications. (Area Under the Curve= 81.69% for IWOCB, 53.79% for eCPR and 69.46% for RCS). Conclusion: VA ECMO indication markedly affects the predictive value of SAVE Score. Prediction of primary outcome in IWOCB patients was reliable. On the contrary, routine application for survival estimation in eCPR patients is not supported from our results.

Abstract 48: Neurological Outcomes of Inpatient Cardiopulmonary Resuscitation in a University Hospital

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Lia M Thomas ◽  
Miguel Benavides ◽  
Pierre Kory ◽  
Samuel Acquah ◽  
Steven Bergmann
Keyword(s):  
Cardiac Arrest ◽  
Critical Care ◽  
Cardiopulmonary Resuscitation ◽  
Therapeutic Hypothermia ◽  
Cardiopulmonary Arrest ◽  
University Hospital ◽  
Neurological Dysfunction ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Neurologically Intact

Background: Despite advances in out- of- hospital resuscitation practices, the prognosis of most patients after a cardiac arrest remains poor. The long term outcomes of patients successfully resuscitated from cardiac arrest are often complicated by neurological dysfunction. Therapeutic hypothermia has significantly improved neurological outcomes in patients successfully resuscitated from out- of- hospital cardiac arrests. The objective of this study was to look into the neurological outcomes in inpatients after successful cardiopulmonary resuscitation (CPR) in a university hospital setting. Methods: This was a retrospective observational study of 68 adult patients who experienced cardiac or respiratory arrest over an 18 month period at a metropolitan teaching hospital with dedicated, trained code teams. Arrests that occurred in the Emergency Department, Critical Care Units or Operating Rooms were excluded. Results: Of the 68 consecutive patients included in this study, 53% were resuscitated successfully. However, only 12 (18%) survived to discharge from the hospital and only 6 (10%) were discharged with intact neurological status. The initial survival was better in patients who received prompt CPR and in those with less co - morbidities. Pulseless electrical activity (PEA) or asystole were the most common rhythms (47% of the arrests). Most patients who survived and were neurologically intact had PEA (67%). We believe that most PEA arrests were more likely severe hypotension with the inability to palpate a pulse rather than true PEA. The mean time to defibrillation for all patients with an initial shockable rhythm (n=5) was 8.2 minutes. Patients who had an initial shockable rhythm and survived to discharge were shocked within 1 minute (n=2). Conclusion: Despite advances in critical care, survival from inpatient cardiopulmonary arrest to neurologically intact discharge remains poor. Therapeutic hypothermia should be expanded to those resuscitated from in - hospital cardiopulmonary arrest to determine if neurological outcomes would improve.

Abstract 309: Prediction Chart for Neurological Outcomes of Elderly Patients with Out-of-hospital Cardiac Arrest and the Corresponding Time to Termination of Resuscitation: Evidence from a Japanese Nationwide Population-based Cohort Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Akira Funada ◽  
Yoshikazu Goto ◽  
Masayuki Takamura
Keyword(s):  
Emergency Department ◽  
Cardiac Arrest ◽  
Elderly Patients ◽  
Service Providers ◽  
Patient Characteristics ◽  
Case Scenario ◽  
Worst Case ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Neurological outcomes and the appropriate duration from call receipt to termination of resuscitation (TOR) in patients with out-of-hospital cardiac arrest (OHCA) could differ according to patient characteristics. Hypothesis: We hypothesized that a prediction chart comprising prehospital variables, including age, could be useful for predicting neurological outcomes and determining the time to TOR in the field or at the emergency department. Methods: We evaluated 19,829 elderly patients with OHCA (age ≥65 years) of cardiac origin who achieved prehospital return of spontaneous circulation (ROSC). Data were obtained from the prospectively recorded All-Japan Utstein Registry between 2011 and 2016. Patients with OHCA witnessed by emergency medical service providers were excluded. The primary outcome was 1-month neurologically intact survival, defined as a cerebral performance category (CPC) score of 1-2. Patients with OHCA were divided into 12 groups according to shockable rhythm (YES/NO), witness status (YES/NO), and age (65-74, 75-89, or ≥90 years). The time from call receipt to ROSC was calculated and categorized by 5-min intervals. The time from call receipt to ROSC at which the probability of 1-month CPC 1-2 decreased to <1% was defined as the call to TOR duration. Results: The overall 1-month CPC 1-2 rate was 18.9% (n = 3,756). When stratified by patient characteristics, the 1-month CPC 1-2 rates ranged from 52.3% in patients aged 65-74 years with shockable rhythm and witnessed OHCA (best-case scenario) to 1.6% in patients aged ≥90 years with non-shockable rhythm and un-witnessed OHCA (worst-case scenario). The corresponding call to TOR duration ranged from 35 to 10 min (Table). Conclusions: Neurological outcomes and the appropriate call to TOR duration differed according to patient characteristics, including age. Our prediction chart for elderly patients with OHCA could be useful for determining TOR in the field or at the emergency department.

scholarly journals Prehospital cardiopulmonary resuscitation duration and neurological outcome after adult out-of-hospital cardiac arrest by location of arrest

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S90-S99
Author(s):  
Takefumi Kishimori ◽  
Tasuku Matsuyama ◽  
Kosuke Kiyohara ◽  
Tetsuhisa Kitamura ◽  
Haruka Shida ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Service ◽  
Neurological Outcome ◽  
Medical Service ◽  
Regression Analyses ◽  
Neurological Outcomes ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest

Background Little is known about the association between prehospital cardiopulmonary resuscitation duration for adults with out-of-hospital cardiac arrest and outcome by the location of arrests. This study aimed to investigate the association between prehospital cardiopulmonary resuscitation duration and one-month survival with favourable neurological outcome. Methods We analysed 276,391 adults aged 18 years and older with out-of-hospital cardiac arrest of medical origin before emergency medical service arrival. Prehospital cardiopulmonary resuscitation duration was defined as the time from emergency medical service-initiated cardiopulmonary resuscitation to prehospital return of spontaneous circulation or to hospital arrival. The primary outcome was one-month survival with favourable neurological outcome (cerebral performance category 1 or 2). The association between prehospital cardiopulmonary resuscitation duration and favourable neurological outcome was assessed using univariable and multivariable logistic regression analyses. Results The proportion of favourable neurological outcomes was 2.3% in total, 7.6% in public locations, 1.5% in residential locations and 0.7% in nursing homes ( P < 0.001). In univariable and multivariable logistic regression analyses, longer prehospital cardiopulmonary resuscitation duration was associated with poor neurological outcome, regardless of arrest location ( P for trend < 0.001). Patients with shockable rhythm in both public and residential locations had better neurological outcome than those in nursing homes at any time point, and residential and public locations had a similar neurological outcome tendency among patients with shockable rhythm. Conclusions Longer prehospital cardiopulmonary resuscitation duration was independently associated with a lower proportion of patients with favourable neurological outcomes. Moreover, the association between prehospital cardiopulmonary resuscitation duration and neurological outcome differed according to the location of arrest and the first documented rhythm.

scholarly journals External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: A multicentre retrospective cohort study

2020 ◽  
Author(s):  
Keita Shibahashi ◽  
Kazuhiro Sugiyama ◽  
Yusuke Kuwahara ◽  
Takuto Ishida ◽  
Atsushi Sakurai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Japanese Population ◽  
Goodness Of Fit ◽  
External Validation ◽  
Predictive Score ◽  
Calibration Plot ◽  
Goodness Of Fit Test ◽  
Neurological Outcomes ◽  
Lemeshow Test ◽  
Hospital Cardiac Arrest

Abstract Background Out-of-hospital cardiac arrest (OHCA) is a global medical problem. The newly-developed simplified out-of-hospital cardiac arrest (sOHCA) and cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of patients admitted alive have not been validated externally. This study was, thus, conducted to externally validate sOHCA and sCAHP scores in a Japanese population. Methods Adult patients resuscitated and admitted to hospitals after intrinsic OHCA (n=2,428, age ≥18 years) were selected from a prospectively collected Japanese database (January 2012–March 2013). We validated sOHCA and sCAHP scores with reference to the original ones in predicting 1-month unfavourable neurological outcomes based on discrimination and calibration measures. Discrimination and calibration were assessed using area under the receiver operating characteristic curve (AUC) and the Hosmer-Lemeshow goodness-of-fit test with calibration plot, respectively. Results One-month unfavourable neurological outcome was observed in 82% of patients. Score availability was significantly higher in the simplified scores than in the original ones and was highest in the sCAHP score (76%). The AUCs of simplified scores were not significantly different from those of original ones, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs. 0.81, P <0.001). Goodness-of-fit was poor in the sOHCA score (ν= 8, χ 2 =19.1, Hosmer-Lemeshow test: P =0.014) but not in the sCAHP score (ν= 8, χ 2 =13.5, Hosmer-Lemeshow test: P =0.10). Conclusion Performance of original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. Based on the highest availability, similar discrimination, and good calibration, the sCAHP score was the better candidate for clinical implementation. The validated predictive score can help patients’ families, healthcare providers, and researchers by accurately stratifying patients.

scholarly journals External validation of simplified out-of-hospital cardiac arrest and cardiac arrest hospital prognosis scores in a Japanese population: a multicentre retrospective cohort study

2021 ◽  
pp. emermed-2020-210103
Author(s):  
Keita Shibahashi ◽  
Kazuhiro Sugiyama ◽  
Yusuke Kuwahara ◽  
Takuto Ishida ◽  
Atsushi Sakurai ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Japanese Population ◽  
Goodness Of Fit ◽  
External Validation ◽  
Calibration Plot ◽  
Goodness Of Fit Test ◽  
Neurological Outcomes ◽  
Hospitalised Patients ◽  
Lemeshow Test ◽  
Hospital Cardiac Arrest

BackgroundThe novel simplified out-of-hospital cardiac arrest (sOHCA) and simplified cardiac arrest hospital prognosis (sCAHP) scores used for prognostication of hospitalised patients have not been externally validated. Therefore, this study aimed to externally validate the sOHCA and sCAHP scores in a Japanese population.MethodsWe retrospectively analysed data from a prospectively maintained Japanese database (January 2012 to March 2013). We identified adult patients who had been resuscitated and hospitalised after intrinsic out-of-hospital cardiac arrest (OHCA) (n=2428, age ≥18 years). We validated the sOHCA and sCAHP scores with reference to the original scores in predicting 1-month unfavourable neurological outcomes (cerebral performance categories 3–5) based on the discrimination and calibration measures of area under the receiver operating characteristic curves (AUCs) and a Hosmer-Lemeshow goodness-of-fit test with a calibration plot, respectively.ResultsIn total, 1985/2484 (82%) patients had a 1-month unfavourable neurological outcome. The original OHCA, sOHCA, original cardiac arrest hospital prognosis (CAHP) and sCAHP scores were available for 855/2428 (35%), 1359/2428 (56%), 1130/2428 (47%) and 1834/2428 (76%) patients, respectively. The AUCs of simplified scores did not differ significantly from those of the original scores, whereas the AUC of the sCAHP score was significantly higher than that of the sOHCA score (0.88 vs 0.81, p<0.001). The goodness of fit was poor in the sOHCA score (ν=8, χ2=19.1 and Hosmer-Lemeshow test: p=0.014) but not in the sCAHP score (ν=8, χ2=13.5 and Hosmer-Lemeshow test: p=0.10).ConclusionThe performances of the original and simplified OHCA and CAHP scores in predicting neurological outcomes in successfully resuscitated OHCA patients were acceptable. With the highest availability, similar discrimination and good calibration, the sCAHP score has promising potential for clinical implementation, although further validation studies to evaluate its clinical acceptance are necessary.

scholarly journals Survival analysis in out-of-hospital cardiac arrest patients with shockable rhythm directly transport to Heart Centers

2021 ◽  
Keyword(s):  
Cardiac Arrest ◽  
Survival Analysis ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Transport Time ◽  
Neurological Outcomes ◽  
Neurologic Outcomes ◽  
Shockable Rhythm ◽  
Short Time ◽  
Hospital Cardiac Arrest

Background: This study aimed to evaluate whether out-of-hospital cardiac arrest (OHCA) patients with initial shockable rhythm without prehospital return of spontaneous circulation (ROSC) who are directly transported to Heart Centers in appropriate time will have better post-cardiac arrest four months survival and neurological outcomes at discharge. Methods: This retrospective study assessed the data of 1,588 OHCA patients with shockable rhythm and without prehospital ROSC collected from the registry database of Taoyuan City between January 2014 and June 2018. The relationships of transport time to Heart Centers with survival at discharge and with neurological outcomes were investigated for survival analysis. Results: Among the 1,588 OHCA patients with initial shockable rhythm and without prehospital ROSC, 1,222 (77.0%) and 366 (23.0%) were transported to Heart Centers and non-Heart Centers, respectively. However, the transport to Heart Centers was associated with an increased survival at discharge (adjusted odds ratio [aOR] 2.00, 95% confidence interval [CI], 1.42–2.81) and good neurological outcomes (cerebral performance category [CPC] 1 and 2) (aOR 3.14, 95% CI, 1.88–5.23), regardless of the transport time. The overall mortality reduction for Heart Centers was 39% (hazard ratio [HR] = 0.61; 95% CI 0.47–0.78), compared to that for non-Heart Centers. At 120 days of follow-up, the results showed a higher survival rate for patients who were transported to Heart Centers within a short time. The percentages of good CPC showed a better distribution for non-Heart Centers versus those for Heart Centers. Conclusions: Adult OHCA patients with initial shockable rhythm and without prehospital ROSC who were transported to Heart Centers directly had better post-cardiac arrest survival and good neurologic outcomes, regardless of the transport time.

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