• Eva V Zadorozny, Francis X Guyette, Katharyn L Flickinger, Christian Martin-Gill, Kaia Amoah, Onaje Artist, Azmina Mohammed, Joseph P Condle, Clifton W Callaway, Jonathan Elmer, Patrick J Coppler, and Pittsburgh Post Cardiac Arrest Service.
• University of Pittsburgh School of Medicine, Department of Emergency Medicine, Pittsburgh, Pennsylvania, USA.
• Am J Emerg Med. 2021 Dec 1; 50: 618-624.

IntroductionOut of hospital cardiac arrest (OHCA) patients are often transported to the closest emergency department (ED) or cardiac center for initial stabilization and may be transferred for further care. We investigated the effects of delay to transfer on in hospital mortality at a receiving facility.MethodsWe included OHCA patients transported from the ED by a single critical care transport service to a quaternary care facility between 2010 and 2018. We calculated dwell time as time from arrest to critical care transport team contact. We abstracted demographics, arrest characteristics, and interventions started prior to transport arrival. For the primary analysis, we used logistic regression to determine the association of dwell time and in-hospital mortality. As secondary outcomes we investigated for associations of dwell time and mortality within 24 h of arrival, proximate cause of death among decedents, arterial pH and lactate on arrival, sum of worst SOFA subscales within 24 h of arrival, and rearrest during interfacility transport.ResultsWe included 572 OHCA patients transported from an outside ED to our facility. Median dwell time was 113 (IQR = 85-159) minutes. Measured in 30 min epochs, increasing dwell time was not associated with in-hospital mortality, 24-h mortality, cause of death and initial pH, but was associated with lower 24-h SOFA score (p = 0.01) and lower initial lactate (p = 0.03). Rearrest during transport was rare (n = 29, 5%). Dwell time was associated with lower probability of rearrest during transport (OR = 0.847, (95% CI 0.68-1.01), p = 0.07).ConclusionsDwell time was not associated with in-hospital mortality. Rapid transport may be associated with risk of rearrest. Prospective data are needed to clarify optimal patient stabilization and transport strategies.Copyright © 2021 Elsevier Inc. All rights reserved.

24 keywords...

hide…