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Impact of cardiac arrest centers on the survival of patients with nontraumatic outâofâhospital cardiac arrest : a systematic review and metaâanalysis
Background
The role of cardiac arrest centers (CACs) in outâofâhospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in outâofâhospital cardiac arrest according to varying definitions of CAC and prespecified subgroups.
Methods and Results
Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if selfâdeclared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Metaâanalyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirtyâsix studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52â2.26]), even when including highâvolume centers (aOR, 1.50 [95% CI, 1.18â1.91]) or including improvedâcare centers (aOR, 2.13 [95% CI, 1.75â2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59â2.32]), even when including highâvolume centers (aOR, 1.74 [95% CI, 1.38â2.18]) or when including improvedâcare centers (aOR, 1.97 [95% CI, 1.71â2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected.
Conclusions
Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic outâofâhospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive