Potential impact of a prehospital redirection system for refractory cardiac arrest

Aim: A change in prehospital redirection practice could potentially increase the proportion of E-CPR eligible patients with out-of-hospital cardiac arrest (OHCA) transported to extracorporeal cardiopulmonary resuscitation (E-CPR) capable centers. The objective of this study was to quantify this potential increase of E-CPR candidates transported to E-CPR capable centers. Methods: Adults with non-traumatic OHCA refractory to 15 min of resuscitation were selected from a registry of adult OHCA collected between 2010 and 2015 in Montreal, Canada. Using this cohort, three simulation scenarios allowing prehospital redirection to E-CPR centers were created. Stringent eligibility criteria for E-CPR and redirection for E-CPR (e.g. age <60 years old, initial shockable rhythm) were used in the first scenario, intermediate eligibility criteria (e.g. age <65 years old, at least one shock given) in the second scenario and inclusive eligibility criteria (e.g. age <70 years old, initial rhythm not equal asystole) in the third scenario. All three scenarios were contrasted with equivalent scenarios in which patients were transported to the closest hospital. Proportions were compared using McNemar's test. Results: The proportion of E-CPR eligible patients transported to E-CPR capable centers increased in each scenario (stringent criteria: 48 [24.5%] vs 155 patients [79.1%], p < 0.001; intermediate criteria: 81 [29.6%] vs 262 patients [95.6%], p < 0.001; inclusive criteria: 238 [23.9%] vs 981 patients [98.5%], p < 0.001). Conclusions: A prehospital redirection system could significantly increase the number of patients with refractory OHCA transported to E-CPR capable centers, thus increasing their access to this potentially life-saving procedure, provided allocated resources are planned accordingly. (C) 2017 Elsevier B.V. All rights reserved.