Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 248-255 , August 2009

Effect of Transport Interval on Out-of-Hospital Cardiac Arrest Survival in the OPALS Study: Implications for Triaging Patients to Specialized Cardiac Arrest Centers

Presented at the 38th annual scientific meeting of the Society for Academic Emergency Medicine, May 2008, Washington, DC.

  • Daniel W. Spaite, MD

      Affiliations

    • Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, AZ
    • Corresponding Author InformationAddress for correspondence: Daniel W. Spaite, MD, Arizona Emergency Medicine Research Center, Department of Emergency Medicine, The University of Arizona, 1501 N Campbell Ave, Tucson, AZ 85724; 520-626-8819, Fax 520-626-2480
  • ,
  • Ian G. Stiell, MD

      Affiliations

    • Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
    • Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada
  • ,
  • Bentley J. Bobrow, MD

      Affiliations

    • Mayo Clinic School of Medicine, Scottsdale, AZ
  • ,
  • Melanie de Boer, PhD

      Affiliations

    • Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, AZ
  • ,
  • Justin Maloney, MD

      Affiliations

    • Ottawa Base Hospital Program, Ottawa, Ontario, Canada
  • ,
  • Kurt Denninghoff, MD

      Affiliations

    • Arizona Emergency Medicine Research Center, Department of Emergency Medicine, College of Medicine, The University of Arizona, Tucson, AZ
  • ,
  • Tyler F. Vadeboncoeur, MD

      Affiliations

    • Mayo Clinic School of Medicine, Jacksonville, FL
  • ,
  • Jonathan Dreyer, MD

      Affiliations

    • Division of Emergency Medicine, University of Western Ontario, London, Ontario, Canada
  • ,
  • George A. Wells, PhD

      Affiliations

    • Department of Epidemiology and Community Medicine, Clinical Epidemiology Program, Ottawa Health Research Institute, Ottawa, Ontario, Canada

Received 5 July 2008 ,Revised 13 November 2008 ,Accepted 26 November 2008.

References 

  1. Sayre MR, White LJ, Brown LH, et al. The National EMS Research Agenda executive summary (Emergency medical services). Ann Emerg Med. 2002;40:636–643
  2. Maio RF, Garrison HG, Spaite DW, et al. Emergency Medical Services Outcomes Project I (EMSOP I): prioritizing conditions for outcomes research. Ann Emerg Med. 1999;33:423–432
  3. Stiell IG, Nesbitt LP, Pickett W, et al. The Ontario Prehospital ALS (OPALS) Major Trauma Study: impact of advanced life-support on survival and morbidity. CMAJ. 2008;178:1141–1152
  4. Stiell IG, Spaite DW, Field B, et al. Advanced life support for out-of hospital respiratory distress. N Engl J Med. 2007;356:2156–2164
  5. Spaite DW. The future of emergency care in the US: the Institute of Medicine Subcommittee on Prehospital Emergency Medical Services. Ann Emerg Med. 2006;48:126–130
  6. Eisenberg MS, Horwood BT, Cummins RO, et al. Cardiac arrest and resuscitation: a tale of 29 cities. Ann Emerg Med. 1990;19:179–186
  7. Nichol G, Detsky AS, Stiell IG, et al. Effectiveness of emergency medical services for victims of out-of-hospital cardiac arrest: a meta-analysis. Ann Emerg Med. 1996;27:700–710
  8. Valenzuela TD, Roe DJ, Nichol G, et al. Outcomes of rapid defibrillation by security officers after cardiac arrest in casinos. N Engl J Med. 2000;343:1206–1209
  9. Kellum MJ, Kennedy KW, Ewy GA. Cardiocerebral resuscitation improves survival of patients with out-of-hospital cardiac arrest. Am J Med. 2006;119:335–340
  10. Bobrow BJ, Clark LL, Ewy GA, et al. Minimally interrupted cardiac resuscitation by emergency medical services for out-of-hospital cardiac arrest. JAMA. 2008;299:1158–1165
  11. Kellermann AL, Staves DR, Hackman BB. In-hospital resuscitation following unsuccessful prehospital advanced cardiac life support: “heroic efforts” or an exercise in futility?. Ann Emerg Med. 1988;17:589–594
  12. Mackintosh AF, Crabb ME, Grainger R, et al. The Brighton resuscitation ambulances: review of 40 consecutive survivors of out-of-hospital cardiac arrest. Br Med J. 1978;1:115–118
  13. Myerburg RJ, Conde CA, Sung RJ, et al. Clinical, electrophysiologic and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med. 1980;68:568–576
  14. Szczygiel M, Wright R, Wagner E, et al. Prognostic indicators of ultimate long-term survival following advanced life support. Ann Emerg Med. 1981;10:566–570
  15. Marco CA. Resuscitation research: future directions and ethical issues. Acad Emerg Med. 2001;8:839–843
  16. Herlitz J, Ekstriim L, Axelssona A, et al. Continuation of CPR on admission to emergency department after out-of-hospital cardiac arrest: occurrence, characteristics and outcome. Resuscitation. 1997;33:223–231
  17. Thel MC, O'Connor CM. Cardiopulmonary resuscitation: historical perspective to recent investigations. Am Heart J. 1999;137:39–48
  18. Peberdy MA, Ornato JP. Post-resuscitation care: is it the missing link in the chain of survival?. Resuscitation. 2005;64:135–137
  19. Peberdy MA, Kaye W, Ornato JP, et al. Cardiopulmonary resuscitation of adults in the hospital: a report of 14720 cardiac arrests from the National Registry of Cardiopulmonary Resuscitation. Resuscitation. 2003;58:297–308
  20. Edgren E, Hedstrand U, Kelsey S, et al. Assessment of neurological prognosis in comatose survivors of cardiac arrest. Lancet. 1994;343:1055–1059
  21. Wijdicks EF, Hijdra A, Young GB, et al. Practice parameter: prediction of outcome in comatose survivors after cardiopulmonary resuscitation (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;67:203–210
  22. Booth CM, Boone RH, Tomlinson G, et al. Is this patient dead, vegetative, or severely neurologically impaired? (assessing outcome for comatose survivors of cardiac arrest). JAMA. 2004;291:870–879
  23. Bernard SA, Gray TW, Buist MD, et al. Treatment of comatose survivors of out-of-hospital cardiac arrest with induced hypothermia. N Engl J Med. 2002;346:557–563
  24. Hypothermia After Cardiac Arrest Study Group. Mild therapeutic hypothermia to improve the neurologic outcome after cardiac arrest. N Engl J Med. 2002;346:549–556
  25. Herlitz J, Castren M, Fribergc H, et al. Post resuscitation care: what are the therapeutic alternatives and what do we know?. Resuscitation. 2006;69:15–22
  26. Langhelle A, Tyvold SS, Lexow K, et al. In-hospital factors associated with improved outcome after out-of-hospital cardiac arrest: a comparison between four regions in Norway. Resuscitation. 2003;56:247–263
  27. Engdahl J, Abrahamsson P, Bang A, et al. Is hospital care of major importance for outcome after out-of-hospital cardiac arrest? (experience acquired from patients with out-of-hospital cardiac arrest resuscitated by the same emergency medical service and admitted to one of two hospitals over a 16-year period in the municipality of Goteborg). Resuscitation. 2000;43:201–211
  28. Lurie KG, Idris A, Holcomb JB. Level 1 cardiac arrest centers: learning from the trauma surgeons. [editorial] Acad Emerg Med. 2005;12:80–81
  29. Davis DP, Fisher R, Aguilar S, et al. The feasibility of a regional cardiac arrest receiving system. Resuscitation. 2007;74:44–51
  30. Stiell IG, Spaite DW, Wells GA, et al. The Ontario Prehospital Advance Life Support (OPALS) Study: rationale and methodology for cardiac arrest patients. Ann Emerg Med. 1998;32:180–190
  31. Jacobs I, Nadkarni V, Bahr J. Cardiac arrest and cardiopulmonary resuscitation outcome reports—update and simplification of the Utstein templates for resuscitation registries: a statement for healthcare professionals from a task force of the International Liaison Committee on Resuscitation. Circulation. 2004;110:3385–3397
  32. Stiell IG, Wells GA, Spaite DW, et al. Modifiable factors associated with improved cardiac arrest survival in a multicenter BLS-D system: OPALS study phase I results. Ann Emerg Med. 1999;33:54–59
  33. Stiell IG, Wells GA, Field BJ, et al. Improved out-of-hospital cardiac arrest survival through the inexpensive optimization of an existing defibrillation program: OPALS Study Phase II. JAMA. 1999;281:1175–1181
  34. Stiell IG, Wells GA, Field B, et al. Advanced cardiac life support in out-of-hospital cardiac arrest. N Engl J Med. 2004;351:647–656
  35. Stiell IG, Nichol G, Wells GA, et al. Health-related quality of life is better for cardiac arrest survivors who received citizen cardiopulmonary resuscitation. Circulation. 2003;108:1939–1944
  36. Spaite DW, Valenzuela TD, Meislin HW, et al. Prospective validation of a new model for evaluating EMS systems by in-field observation of specific time intervals in prehospital care. Ann Emerg Med. 1993;22:638–645
  37. Eckstein M, Stratton S, Chan L. Cardiac Arrest Resuscitation Evaluation in Los Angeles: CARE-LA. Ann Emerg Med. 2005;45:504–509
  38. Lombardi G, Gallagher EJ, Gennis P. Outcome of out-of-hospital cardiac arrest in New York City: the Pre-Hospital Arrest Survival Evaluation (PHASE) Study. JAMA. 1994;271:678–685
  39. Becker LB, Ostrander LP, Barrett J, et al. Outcome of CPR in a large metropolitan area—where are the survivors?. Ann Emerg Med. 1991;20:355–361
  40. Nolan JP, Laver SR, Welch CA, et al. Outcome following admission to UK intensive care units after cardiac arrest: a secondary analysis of the ICNARC Case Mix Programme Database. Anaesthesia. 2007;62:1207–1216
  41. Mashiko K, Otsuka T, Shimazaki S, et al. An outcome study of out-of-hospital cardiac arrest using the Utstein template—a Japanese experience. Resuscitation. 2002;55:241–246
  42. Herlitz J, Engdahl J, Svensson L, et al. Major differences in 1-month survival between hospitals in Sweden among initial survivors of out-of-hospital cardiac arrest. Resuscitation. 2006;70:404–409
  43. Zandbergen EG, de Haan RJ, Stoutenbeek CP, et al. Systematic review of early prediction of poor outcome in anoxic-ischaemic coma. Lancet. 1998;352:1808–1812
  44. Zandbergen EG, Hijdra A, Koelman JH, et al. Prediction of poor outcome within the first 3 days of postanoxic coma. Neurology. 2006;66:62–68
  45. Plaisance P, Lurie KG, Vicaut E, et al. A comparison of standard cardiopulmonary resuscitation and active compression-decompression resuscitation for out-of-hospital cardiac arrest. N Engl J Med. 1999;341:569–575
  46. Oddo M, Schaller M, Feihl F, et al. From evidence to clinical practice: effective implementation of therapeutic hypothermia to improve patient outcome after cardiac arrest. Crit Care Med. 2006;34:1865–1873
  47. Belliard G, Cateza E, Charrona C, et al. Efficacy of therapeutic hypothermia after out-of-hospital cardiac arrest due to ventricular fibrillation. Resuscitation. 2007;75:252–259
  48. Arrich J. Clinical application of mild therapeutic hypothermia after cardiac arrest. Crit Care Med. 2007;35:1041–1047
  49. Busch M, Soreide E, Lossius HM, et al. Rapid implementation of therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors. Acta Anaesthesiol Scand. 2006;50:1277–1283
  50. Nolan JP, Morley PT, Vanden Hoek TL, et al. Therapeutic hypothermia after cardiac arrest: ILCOR advisory statement. Resuscitation. 2003;57:231–237
  51. International Liaison Committee for Resuscitation. Postresuscitation support: consensus guidelines from ILCOR on emergency cardiac care and CPR. Circulation. 2005;112(suppl):IV-84–IV-88
  52. Abella BS, Rhee JW, Huang KN, et al. Induced hypothermia is underused after resuscitation from cardiac arrest: a current practice survey. Resuscitation. 2005;64:181–186
  53. Merchant RM, Soar J, Skrifvars MB, et al. Therapeutic hypothermia utilization among physicians after resuscitation from cardiac arrest. Crit Care Med. 2006;34:1935–1940
  54. Borger van der Burg AE, Bax JJ, Boersma E, et al. Impact of percutaneous coronary intervention or coronary artery bypass grafting on outcome after nonfatal cardiac arrest outside the hospital. Am J Cardiol. 2003;91:785–789
  55. Spaulding CM, Joly LM, Rosenberg A, et al. Immediate coronary angiography in survivors of out-of-hospital cardiac arrest. N Engl J Med. 1997;336:1629–1633
  56. Sunde K, Pytte M, Jacobsen D, et al. Implementation of a standardized treatment protocol for post resuscitation care after out-of-hospital cardiac arrest. Resuscitation. 2007;73:29–39
  57. Zeiner A, Holzer M, Sterz F, et al. Hyperthermia after cardiac arrest is associated with an unfavorable neurologic outcome. Arch Intern Med. 2001;161:2007–2012
  58. Huang L, Weil MH, Tang W, et al. Comparison between dobutamine and levosimendan for management of postresuscitation myocardial dysfunction. Crit Care Med. 2005;33:487–491
  59. Ruiz-Bailen M, Aguayo de Hoyos E, Ruiz-Navarro S, et al. Reversible myocardial dysfunction after cardiopulmonary resuscitation. Resuscitation. 2005;66:175–181
  60. Balan IS, Fiskum G, Hazelton J, et al. Oximetry-guided reoxygenation improves neurological outcome after experimental cardiac arrest. Stroke. 2006;37:3008–3013
  61. Sung K, Lee YT, Park PW, et al. Improved survival after cardiac arrest using emergent autopriming percutaneous cardiopulmonary support. Ann Thorac Surg. 2006;82:651–656
  62. Nichol G, Karmy-Jones R, Salerno C, et al. Systematic review of percutaneous cardiopulmonary bypass for cardiac arrest or cardiogenic shock states. Resuscitation. 2006;70:381–394
  63. Nagao K, Hayashi N, Kanmatsuse K, et al. Cardiopulmonary cerebral resuscitation using emergency cardiopulmonary bypass, coronary reperfusion therapy and mild hypothermia in patients with cardiac arrest outside the hospital. J Am Coll Cardiol. 2000;36:776–783
  64. Oksanen T, Skrifvars MB, Varpula T, et al. Strict versus moderate glucose control after resuscitation from ventricular fibrillation. Intensive Care Med. 2007;33:2093–2100
  65. Aufderheide TP, Sigurdsson G, Pirrallo RG, et al. Hyperventilation-induced hypotension during cardiopulmonary resuscitation. Circulation. 2004;109:1960–1965
  66. Lurie KG. The impact of post-arrest care on outcomes in out-of-hospital cardiac arrest. Orlando, FL: Proceedings of the Resuscitation Science Sessions of the annual Scientific Assembly of the American Heart Association; 2007;November 3-4
  67. Mackenzie EJ, Rivara FP, Jurkovich GJ, et al. A national evaluation of the effect of trauma center care on mortality. N Engl J Med. 2006;354:366–374
  68. Eastman AB, Lewis FR, Champion HR, et al. Regional trauma system design: critical concepts. Am J Surg. 1987;154:79–87
  69. Spaite DW, Bobrow BJ, Vadeboncoeur TF, et al. 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

 Provide feedback on this article at the journal's Web site, www.annemergmed.com.

 Supervising editor: Donald M. Yealy, MD.

 Author contributions: DWS, IGS, JM, JD, and GAW conceived the OPALS study, designed the original trial, obtained research funding, and supervised the conduct of the trial and data collection. All authors made substantial contributions to the conception and design of this secondary analysis and analyzed the meaning, conclusions, and limitations of the results. MDB and GAW provided statistical advice, and MDB analyzed the data and served as the statistical consultant. DWS drafted the article, and all authors contributed substantially to its revision. DWS takes responsibility for the paper as a whole.

 Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article that might create any potential conflict of interest. See the Manuscript Submission Agreement in this issue for examples of specific conflicts covered by this statement. Funded by Ontario Ministry of Health and Canadian Health Services Research Foundation.

 Publication date: Available online January 23, 2009.

 Reprints not available from the authors.

PII: S0196-0644(08)02060-X

doi: 10.1016/j.annemergmed.2008.11.020

Annals of Emergency Medicine
Volume 54, Issue 2 , Pages 248-255 , August 2009