Editor's Capsule Summary
What is already known on this topic
Expert postarrest care improves out-of-hospital cardiac arrest outcomes.
What question this study addressed
Does regionalization of postarrest care improve out-of-hospital cardiac arrest outcomes?
What this study adds to our knowledge
In this before-after analysis, a statewide strategy of EMS bypass to specialized postarrest care centers resulted in improved neurologically intact out-of-hospital cardiac arrest survival.
How this is relevant to clinical practice
If the results can be replicated, communities should consider out-of-hospital cardiac arrest care regionalization strategies.
For decades, out-of-hospital cardiac arrest has been a major focus of emergency medical services (EMS) systems, and several bystander and EMS interventions have been shown to improve outcomes.1, 2, 3, 4, 5, 6, 7, 8, 9, 10 In contrast, inhospital postarrest care of out-of-hospital cardiac arrest has historically received little attention. The consensus was that, if a patient was not “saved” in the field, the likelihood that hospital care would make any significant difference was very low.11, 12 However, in the late 1990s, major interest in postarrest care was sparked by observational studies showing a potential effect of inhospital interventions, even in some patients with major neurologic deficits.13, 14, 15, 16 There is an increasing amount of literature and consensus that specialized postarrest care, including therapeutic hypothermia and targeted temperature management, improves out-of-hospital cardiac arrest outcomes.17, 18, 19 In response, international recommendations for the use of therapeutic hypothermia were published.20, 21, 22 There is also an increasing amount of literature reporting that a wide range of interventions, combined with standardized comprehensive critical care, may improve outcome.15, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38
In 2004, the Arizona Department of Health Services developed a statewide partnership with EMS agencies and researchers focusing on out-of-hospital cardiac arrest. The net effect was improvement in bystander and EMS care that led to a tripling of survival statewide.7, 44, 45 In 2007, this partnership established criteria for a statewide network of specialized cardiac receiving centers that could provide therapeutic hypothermia, prompt percutaneous coronary interventions, and other guideline-based postarrest critical care. In 2008, protocols were developed allowing EMS to bypass local hospitals to preferentially transport patients to cardiac receiving centers.
The goal for this study was to evaluate whether statewide regionalization of postarrest interventions, combined with EMS triage, would be associated with improved survival and neurologic outcome. Here we report the outcomes of this effort.