Alexis Cournoyer1, Éric Notebaert2, Luc de Montigny3, Dave Ross4, Sylvie Cossette5, Luc Londei-Leduc6, Massimiliano Iseppon2, Yoan Lamarche7, Catalina Sokoloff8, Brian J Potter8, Alain Vadeboncoeur5, Dominic Larose5, Judy Morris2, Raoul Daoust2, Jean-Marc Chauny2, Éric Piette2, Jean Paquet9, Yiorgos Alexandros Cavayas2, François de Champlain10, Eli Segal11, Martin Albert7, Marie-Claude Guertin12, André Denault13. 1. Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada. Electronic address: alexis.cournoyer@umontreal.ca. 2. Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada. 3. Corporation d'Urgences-santé, Montréal, Québec, Canada. 4. Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Corporation d'Urgences-santé, Montréal, Québec, Canada. 5. Université de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada. 6. Université de Montréal, Montréal, Québec, Canada; Corporation d'Urgences-santé, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada. 7. Université de Montréal, Montréal, Québec, Canada; Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada. 8. Université de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada. 9. Hôpital du Sacré-Cœur de Montréal, Montréal, Québec, Canada. 10. Corporation d'Urgences-santé, Montréal, Québec, Canada; Université McGill, Montréal, Québec, Canada; Centre Universitaire de Santé McGill, Montréal, Québec, Canada. 11. Corporation d'Urgences-santé, Montréal, Québec, Canada; Université McGill, Montréal, Québec, Canada; Hôpital général juif de Montréal, Montréal, Québec, Canada. 12. Institut de Cardiologie de Montréal, Montréal, Québec, Canada. 13. Université de Montréal, Montréal, Québec, Canada; Institut de Cardiologie de Montréal, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada.
Abstract
AIMS: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital. Percutaneous coronary intervention (PCI) is often indicated following OHCA. This study's primary objective was to determine the association between being transported to a PCI-capable hospital and survival to discharge for patients with OHCA. The additional delay to hospital arrival which could offset a potential increase in survival associated with being transported to a PCI-capable center was also evaluated. METHODS: This study used a registry of OHCA in Montreal, Canada. Adult patients transported to a hospital following a non-traumatic OHCA were included. Hospitals were dichotomized based on whether PCI was available on-site or not. The effect of hospital type on survival to discharge was assessed using a multivariable logistic regression. The added prehospital delay which could offset the increase in survival associated with being transported to a PCI-capable center was calculated using that regression. RESULTS: A total of 4922 patients were included, of whom 2389 (48%) were transported to a PCI-capable hospital and 2533 (52%) to a non-PCI-capable hospital. There was an association between being transported to a PCI-capable center and survival to discharge (adjusted odds ratio = 1.60 [95% confidence interval 1.25-2.05], p < .001). Increasing the delay from call to hospital arrival by 14.0 min would offset the potential benefit of being transported to a PCI-capable center. CONCLUSIONS: It could be advantageous to redirect patients suffering from OHCA patients to PCI-capable centers if the resulting expected delay is of less than 14 min.
AIMS: Patients suffering from out-of-hospital cardiac arrest (OHCA) are frequently transported to the closest hospital. Percutaneous coronary intervention (PCI) is often indicated following OHCA. This study's primary objective was to determine the association between being transported to a PCI-capable hospital and survival to discharge for patients with OHCA. The additional delay to hospital arrival which could offset a potential increase in survival associated with being transported to a PCI-capable center was also evaluated. METHODS: This study used a registry of OHCA in Montreal, Canada. Adult patients transported to a hospital following a non-traumatic OHCA were included. Hospitals were dichotomized based on whether PCI was available on-site or not. The effect of hospital type on survival to discharge was assessed using a multivariable logistic regression. The added prehospital delay which could offset the increase in survival associated with being transported to a PCI-capable center was calculated using that regression. RESULTS: A total of 4922 patients were included, of whom 2389 (48%) were transported to a PCI-capable hospital and 2533 (52%) to a non-PCI-capable hospital. There was an association between being transported to a PCI-capable center and survival to discharge (adjusted odds ratio = 1.60 [95% confidence interval 1.25-2.05], p < .001). Increasing the delay from call to hospital arrival by 14.0 min would offset the potential benefit of being transported to a PCI-capable center. CONCLUSIONS: It could be advantageous to redirect patients suffering from OHCA patients to PCI-capable centers if the resulting expected delay is of less than 14 min.
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