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We aimed to investigate the interaction effects between transfer to a heart attack centre [HAC] and prehospital re-arrest on the clinical outcomes of patients with out-of-hospital cardiac arrest [OHCA]. We included adult patients with OHCA of presumed cardiac aetiology from January 2012 to December 2018. The main exposure variable was prehospital re-arrest, defined as recurrence of cardiac arrest with a loss of palpable pulse upon hospital arrival. The other exposure variable was the resuscitation capacity of the receiving hospital [HAC or Non-HAC]. The outcome variable was neurological recovery. A multivariable logistic regression was performed to determine the interaction effects. The final analysis included 6935 patients. Of these, 21.9% (n = 1521) experienced prehospital re-arrest, whereas 41.3% (n = 2866) were transferred to a non-HAC. The prehospital re-arrest group associated with poor neurological recovery (adjusted odds ratio [AOR], 0.25; 95% confidence interval [CI], 0.21-0.29;). Transfer to an HAC had beneficial effects on neurological recovery (AOR, 3.40 [95% CI, 3.04-3.85]. In the interaction model, wherein prehospital re-arrest patients who were transferred to a non-HAC were used as reference, the AOR of prehospital re-arrest patients who were transferred to an HAC, non-re-arrest patients who were transferred to a non-HAC, and non-re-arrest patients who were transferred to a non-HAC was 2.41 (95% CI, 1.73-3.35), 3.09 (95% CI, 2.33-4.10), and 11.07 (95% CI, 8.40-14.59) respectively (interaction p = 0.001). Transport to a heart attack centre was beneficial to the clinical outcomes of patients who achieved prehospital ROSC after OHCA. The magnitude of that benefit was significantly modified by whether prehospital re-arrest had occurred. Copyright © 2021 Elsevier B.V. All rights reserved.

Citation

Hanna Yoon, Ki Ok Ahn, Jeong Ho Park, Sun Young Lee. Effects of pre-hospital re-arrest on outcomes based on transfer to a heart attack centre in patients with out-of-hospital cardiac arrest. Resuscitation. 2022 Jan;170:107-114

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PMID: 34822934

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