Does transport time of out-of-hospital cardiac arrest patients matter? A systematic review and meta-analysis

• Published in: Resuscitation 2017-06, Vol.115, p.96-101
• Main Authors: Geri, Guillaume, Gilgan, Joshua, Wu, Wen, Vijendira, Sandy, Ziegler, Carolyn, Drennan, Ian R, Morrison, Laurie, Lin, Steve
• Format: Article
• Language: English
• Subjects: Cardiopulmonary Resuscitation - mortality; Emergency; Emergency Medical Services; Female; Humans; Male; Meta-analysis; Observational Studies as Topic; Out-of-hospital cardiac arrest; Out-of-Hospital Cardiac Arrest - mortality; Outcome; Retrospective Studies; Risk Factors; Survival; Systematic review; Time Factors; Transport time; Transportation of Patients - statistics & numerical data
• ISSN: 0300-9572; 1873-1570
• DOI: 10.1016/j.resuscitation.2017.04.003

Abstract Background Despite increasing evidence for specialized cardiac arrest centres, the impact of transport time on out-of-hospital cardiac arrest (OHCA) patients’ outcome remains unclear. We systematically reviewed the prognostic impact of transport time in OHCA patients. Methods We searched PubMed, Embase, the Cochrane Library, and Web of Science from inception to May 2016 for studies that had reported the relationship between transport time and outcome in OHCA patients. The primary outcome was survival at hospital discharge. The secondary outcomes included neurological outcome at hospital discharge and long-term outcome. Results From a total of 3,454 titles retrieved from the literature search, 9 studies were included for final analysis. All nine studies (N = 46,417) were retrospective observational studies. OHCA patients included were mostly male (61-76%), suffered a witnessed cardiac arrest in half of the cases, and had an initial shockable rhythm in one third of cases. The overall survival to hospital discharge for all cardiac rhythms was less than 6%. There was no evidence for a differential mortality risk in OHCA patients according to transport time (mean difference -0.05 min [-0.86,0.76]; I2 25%; 4 studies, 2197 patients). Conclusion Paramedic transport time was not associated with survival to hospital discharge or with neurological outcome at hospital discharge in adult OHCA patients. Future studies are needed to prospectively evaluate the prognostic impact of transport time particularly in rural settings and pediatric population.