Relationship between hospital characteristics and survival outcomes in out of hospital cardiac arrest (OHCA) patients treated and transported by Yorkshire Ambulance Service (YAS)

Abstract

Background There is mounting evidence that post resuscitation care, should include early angiography and primary percutaneous coronary intervention (PPCI) in OHCA where a cardiac cause is suspected. In Yorkshire, the ambulance service can transport patients with a return of spontaneous circulation (ROSC), directly to a regional PPCI unit, if their ECG shows ST elevation myocardial infarction (STEMI) and the PPCI units accept. The aim of this study was to evaluate transport decisions, hospital characteristics and outcome in the form of 30 day survival rates of post-ROSC patients with presumed cardiac aetiology. Methods OHCA patient care records (PCRs) between January and July 2017 were reviewed. Patients were eligible for inclusion if they were: an adult non-traumatic OHCA: achieved ROSC on scene, and were transported to hospital. Descriptive statistics were used to analyse the data. Results 478 patients met the inclusion criteria. 361/478 (75.6%) patients had an ECG recorded, with 149/361 (41.3%) documented cases of STEMI and 88/149 (59.1%) referred to a PPCI unit. 40/88 (45.5%) of referrals made were accepted by PPCI. Patients taken directly to PPCI were most likely to survive to 30 days (25/39, 53.8%). 34/126 (27.0%) patients survived to 30 days after transport to an emergency department (ED) at a PPCI- capable hospital, and 50/310 (16.1%) survived if taken to ED at a non-PPCI capable hospital. Conclusion Work is required to ensure post-ROSC patients receive a 12 lead ECG, and those with STEMI are referred to PPCI, as survival was greatest in this group. 30 day survival was better for patients taken to ED at a hospital with PPCI facilities, than an ED at a general hospital. Discussion needs to take place between YAS and the relevant hospitals in the region to ensure patients are transported to the appropriate destination., https://emj.bmj.com/content/36/10/e6.1 This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ DOI http://dx.doi.org/10.1136/emermed-2019-999abs.11