Safety concerns about bypassing hospitals were allayed by two studies conducted by the authors prior to implementation. The Save Hearts in Arizona Registry & Education (SHARE) database showed that there is no increase in the risk of death when patients spend longer in transport, a finding corroborated by the OPALS database.^2,3 The protocol in the current study directs EMS agencies to bypass a closer hospital so long as it increases transport interval by no more than 15 minutes.

This is the first study to look at the impact, across an entire state, of regionalization of coordinated out-of-hospital cardiac arrest treatment and transport, as endorsed by the American Heart Association in 2010, Dr. Spaite said.⁴ “It makes us optimistic that this voluntary model of implementation may be transportable to many other settings since it was successful across such a wide variety of EMS systems and receiving facilities.”

The prospective before-and-after study’s findings are consistent with the intent of regionalization and are associated with significant increases in both the number of patients arriving at CRC-designated hospitals and the use of guideline therapies, the Annals article notes. Provision of therapeutic hypothermia among patients who had return of spontaneous circulation increased from 0 percent to 44 percent, while provision of cardiac cath/PCI went from 11.7 percent to 30.7 percent.

The authors encourage emergency physicians to adapt this approach in their own hospitals, EMS systems, and communities. “If you are an emergency medicine leader in your hospital, there’s no reason why you can’t work with other hospitals and EMS leaders to implement this model in your own system,” Dr. Spaite said.

References

1. Spaite DW, Bobrow BJ, Stolz U, et al. Statewide regionalization of postarrest care for out-of-hospital cardiac arrest: association with survival and neurologic outcome. Ann Emerg Med. 2014 Jul 23. pii: S0196-0644(14)00487-9. Spaite DW, Bobrow BJ, Vadedoboncoeur TF, et al.
2. The impact of prehospital transport interval on survival in out-of-hospital cardiac arrest: implications for regionalization of post-resuscitation care. Resuscitation. 2008;79:61-66.
3. Spaite DW, Stiell IG, Bobrow BJ, et al. Effect of transport interval on out-of-hospital cardiac arrest survival in the OPALS study: implications for triaging patients to specialized cardiac arrest centers. Ann Emerg Med. 2009;54:248-255.
4. Nichol G, Aufderheide TP, Eigel B, et al. American Heart Association policy statement: Regional systems of care for out-of-hospital cardiac arrest. Circulation. 2010;121:709-729.

Mr. Beresford is a freelance journalist based in California.