Regional Cardiac Arrest Centers Increase Odds of Survival

By Christopher Cheney

Cardiac arrest patients would benefit from a regionalized system of care similar to tiered trauma centers, recent research indicates.

In high-income countries, sudden cardiac arrest is the most common cause of death. For patients who achieve return of spontaneous circulation and are taken to a hospital, most do not survive to discharge.

With a patient population drawn from southwestern Pennsylvania, Ohio, West Virginia, and Maryland, the researchers targeted hospitals that received cardiac arrest patients transferred from other hospitals. These “cardiac arrest receiving centers” were viewed as the best facilities locally.

“Both early interfacility transfer to a cardiac arrest receiving center and direct transport to a cardiac arrest receiving center from the scene are independently associated with reduced mortality,” the researchers wrote.

The study, based on 5,000 cases of cardiac arrest, found that treatment at a cardiac arrest receiving center generated a 27% decrease in hazard of death compared to treatment at other hospitals.

Regionalizing cardiac arrest care is a golden opportunity, the researchers wrote. “Given the prevalence of out-of-hospital sudden cardiac arrest, the potential for improved outcomes through optimization of regionalized care is considerable.”

Excelling in cardiac arrest care

The lead author of the research, Jonathan Elmer, MD, MS, at the University of Pittsburgh School of Medicine in Pittsburgh, told Healthleaders recently that transfer was a key metric for cardiac arrest receiving centers.

“We focused on centers that received large numbers of patients via interfacility transfer. These centers are viewed locally as centers of excellence, and the centers shipping out patients were the feeder hospitals,” he said.

Cardiac arrest receiving centers need to be strong in at least four areas, Elmer said.

• Cardiac arrest and post-arrest care is complex and time-sensitive, so patients need a diverse team of clinicians beyond a cardiologist
• Hospitals should have a robust system of local expertise in heart, brain, and general critical care
• There needs to be continuum of care coverage from the early stage of resuscitation through prognostication and prediction of outcome
• Bridges should link acute hospitalization to post-acute rehabilitation settings

Patients with average acuity could be best suited for treatment at a cardiac arrest receiving center because few patients survive severe cardiac arrest and mild cases can be treated at most hospitals, Elmer said. “Patients who are too well or too sick to benefit from tertiary care are patients who are probably best cared for near their family.”