Methodology: 5/5
Usefulness: 3/5

Patterson T, et al. Lancet. 2023 Oct 14;402(10410):1329-1337.

Patients who sustain an out-of-hospital cardiac arrest without signs of ST elevation had no improvement in mortality or functional neurological outcomes when transported to a cardiac arrest centre compared to standard of care.

Question and Methods: In patients with non-ST elevation OHCA, does transportation to a cardiac arrest centre compared to standard of care improve mortality?

Findings: There was no significant difference between non-ST elevation OHCA patients transported to a cardiac arrest centre compared to standard care (ARR -0.2%; CI -6.5 to 6.8)

Limitations: Study was done in London, UK, a city with excellent prehospital care with the London Ambulance Service (time from arrest to CPR and defib was about 10 min in both groups!). Most notably there are 35 different acute care hospitals in the city and results may not be applicable to cities and especially rural communities with fewer hospitals and longer transit times. That being said, I don’t think transit times actually plays a big factor in this study as they were still quite long (84min and 77min) despite time to ROSC being short (24min and 25min). This may suggest that what is being done pre-hospital pre-ROSC matters a lot more than the care provided in-hospital post-ROSC for non-ST elevation OHCA.

Interpretation: Patients who sustain OHCA without signs of ST elevation in Ottawa should be transported to the nearest hospital in the city, rather than to the Heart Institute.

By: Dr. William Wu

JC Supervisor: Dr. Jeff Perry