Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania 15261, USA.
Prehosp Emerg Care. 2011 Jul-Sep;15(3):381-7. doi: 10.3109/10903127.2011.561409. Epub 2011 Apr 4.
Cardiac arrest center (CAC) criteria are not well defined, nor is their potential impact on current emergency medical services (EMS) transportation practices for post-cardiac arrest (PCA) patients. In addition to the availability of emergent cardiac catheterization (CATH) and therapeutic hypothermia (TH), high-volume centers and those with PCA protocols have been associated with improved outcomes. Objectives. This study aimed 1) to identify the PCA treatment capabilities of receiving hospitals in a 10-county regional EMS system without official CAC designation and 2) to determine the proportion of PCA patients who are transported to hospitals meeting three proposed CAC definitions. We hypothesized that a majority of patients are already transported to hospitals that meet proposed CAC criteria.
We distributed a survey to 34 receiving hospitals to determine availability and volume of CATH, TH, a PCA protocol, and a 24-hour intensivist. We conducted a retrospective study of adult, nontrauma cardiac arrest patients transported with a pulse from 2006 to 2008 for 16 EMS agencies. The proportions of patients transported to hospitals meeting three CAC criteria were compared: criteria A (availability of CATH and TH), criteria B (criteria A, >200 CATHs per year, and a PCA protocol), and criteria C (criteria B and a 24-hour intensivist).
Data were obtained from 31 of 34 hospitals (91.1%), of which 10 (32.3%) met criteria A, seven (22.6%) met criteria B, and six (19.4%) met criteria C. Of 1,193 cardiac arrest patients, 46 (3.9%) were excluded because of transport to a pediatric, closed, or out-of-region hospital. There were 335 patients (81.1%) with return of spontaneous circulation and a pulse present upon arrival at the destination facility transported to hospitals meeting criteria A, 304 patients (73.6%) transported to hospitals meeting criteria B, and 273 patients (66.1%) transported to hospitals meeting criteria C.
In a region without official CAC designation, only one-third of hospitals meet basic CAC criteria (CATH and TH), but those facilities receive 81% of PCA patients. Fewer patients (66%) are transported to hospitals meeting more stringent CAC criteria. These data describe the potential impact of developing a CAC policy based on current transportation practices.
心脏骤停中心（CAC）的标准尚未明确，其对当前心脏骤停后（PCA）患者的急救医疗服务（EMS）转运实践的潜在影响也不明确。除了紧急心脏导管插入术（CATH）和治疗性低温（TH）的可用性外，大容量中心和有 PCA 方案的中心与改善预后有关。目的：本研究旨在 1）确定在一个 10 县区域 EMS 系统中没有官方 CAC 指定的接收医院的 PCA 治疗能力，2）确定被转运至符合三个拟议 CAC 定义的医院的 PCA 患者比例。我们假设大多数患者已经被转运至符合拟议 CAC 标准的医院。
我们向 34 家接收医院发放了一份调查问卷，以确定 CATH、TH、PCA 方案和 24 小时重症监护医师的可用性和数量。我们对 2006 年至 2008 年 16 家 EMS 机构转运的有脉搏的成年非创伤性心脏骤停患者进行了回顾性研究。比较了符合三个 CAC 标准的患者的转运比例：标准 A（CATH 和 TH 的可用性）、标准 B（标准 A，每年 >200 次 CATH 和 PCA 方案）和标准 C（标准 B 和 24 小时重症监护医师）。
从 34 家医院中获得了 31 家（91.1%）的数据，其中 10 家（32.3%）符合标准 A，7 家（22.6%）符合标准 B，6 家（19.4%）符合标准 C。在 1193 例心脏骤停患者中，46 例（3.9%）因转运至儿科、关闭或区域外医院而被排除在外。有 335 例（81.1%）自主循环恢复且到达目的地时存在脉搏的患者被转运至符合标准 A 的医院，304 例（73.6%）被转运至符合标准 B 的医院，273 例（66.1%）被转运至符合标准 C 的医院。
在没有官方 CAC 指定的地区，只有三分之一的医院符合基本 CAC 标准（CATH 和 TH），但这些医院接收了 81%的 PCA 患者。符合更严格 CAC 标准的患者（66%）较少被转运。这些数据描述了根据当前转运实践制定 CAC 政策的潜在影响。
