7/5/2018

PITTSBURGH – Direct transport or early transfer to a cardiac receiving center—a facility that provides specialized care to cardiac patients—improves chances for long-term survival of people who survive resuscitation after sudden cardiac arrest, a new University of Pittsburgh School of Medicine analysis discovered. Outcomes were better whether they were transported directly to specialty care from the scene of their arrest, or transferred from another hospital’s emergency department. The research, funded by the National Institutes of Health, is available online in the journal

Sudden cardiac arrest occurs when the heart abruptly stops beating, and is the leading cause of death in the United States and other high-income nations. Each year, emergency medical services (EMS) treat more than 350,000 cardiac arrest patients in the United States, but only half survive to hospital care. Fewer than 12 percent survive to leave the hospital, according to the American Heart Association.

“Caring for patients after cardiac arrest is complex and time sensitive. Currently, EMS or referring emergency department providers decide whether to transfer patients to specialty receiving centers,” said lead author Jonathan Elmer, M.D., M.S., assistant professor, departments of Emergency Medicine, Critical Care Medicine and Neurology at Pitt’s School of Medicine. “We’ve known for a long time that in other complex, life-threatening conditions like stroke and major trauma, referral to specialty centers saves lives. Our findings do not diminish the quality of care provided at smaller hospitals, but support the call for regionalized systems of post-arrest care that resemble those developed for stroke or trauma.”

Elmer and his colleagues analyzed data from 5,217 sudden cardiac arrest cases treated by 78 EMS agencies throughout southwestern Pennsylvania and neighboring Ohio, West Virginia and Maryland between January 2010 and November 2014. Patients were followed for up to five years after their initial arrest. Treatment at specialty centers was associated with a 16 percent reduction in the hazard of long-term mortality, compared with treatment at non-specialty centers.

Francis X. Guyette, M.D., M.S., of Pitt, is senior author on this study. Additional co-authors include Clifton W. Callaway, M.D., Ph.D., Christian Martin-Gill, M.D., M.P.H., Chung-Chou Chang, Ph.D., David J. Wallace, M.D., and Denisse Sequeira, B.S., all of Pitt; Jonathan Madaras, M.P.A., N.R.P., Phillip Nawrocki, M.D., and Arvind Verkat, M.D., all of Allegheny Health Network; Kristen A.C. Seaman, M.D., and Owen T. Traynor, M.D., both of Saint Clair Hospital; and Heather Walker, M.D., of Excela Health.

This research was funded by the National Institutes of Health grants 5K12HL109068, 1K23NS097629, and K08HL122478.