OHCA: on-scene resuscitation is linked to better outcomes vs intra-arrest transport

  • Grunau B & al.
  • JAMA
  • 15/09/2020

  • Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • On-scene resuscitation for patients experiencing out-of-hospital cardiac arrest (OHCA) may result in better outcomes than transport during resuscitation.
  • Authors: “in many settings, conventional advanced life support resuscitation can be fully implemented in the out-of-hospital setting so that there is no clear hospital-based advantage.”

Why this matters

  • Emergency medical service policies vary on whether to transport these patients before return of spontaneous circulation (ROSC).
  • Transport may delay or erode the quality of resuscitation.

Key results

  • Intra-arrest transport vs on-scene resuscitation:
    • Survival to hospital discharge: 4.0% vs 8.5%.
      • Risk difference (RD): 4.6% (95% CI, 4.0%-5.1%). 
      • Adjusted risk ratio (aRR): 0.48 (95% CI, 0.43-0.54).
    • Favorable neurological outcome: 2.9% vs 7.1%.
      • RD: 4.2% (95% CI, 3.5%-4.9%). 
      • aRR: 0.60 (95% CI, 0.47-0.76).
  • Similar findings in subgroup analyses.

Study design

  • Secondary analysis of prospectively collected registry data at 10 North American sites in Resuscitation Outcomes Consortium (n=43,969).
  • Authors compared 2 groups:
    • Those whose transport began at a time point before ROSC (intra-arrest transport).
    • Those who received continued on-scene resuscitation at same time point.
  • Time-dependent propensity score created matched cohort (n=27,705).
  • Outcome: survival to hospital discharge.
  • Funding: National Heart, Lung, and Blood Institute; Canadian Institutes of Health Research; others.

Limitations

  • Observational study with potential confounders.