Closest hospital may not be best for stopped heart

NEW YORK (Reuters Health) - If your heart stops beating, it might be better to bypass a nearby local hospital in favor of going to a specialized cardiac arrest center, according to new research.

The study, by Dr. Daniel W. Spaite, from The University of Arizona, Tucson, and colleagues, found that the time it takes for an ambulance to transport a patient who suffers from cardiac arrest - the clinical term for a stopped heart -- from the field to the hospital has no significant effect on survival.

Prior research has shown that the care delivered at the scene of a cardiac arrest can affect outcomes. The impact of the transport time following scene interventions, however, was unclear, according to the report in the Annals of Emergency Medicine.

Spaite's team analyzed data from more than 15,000 people in the Ontario Prehospital Advanced Life Support (OPALS) study, which was conducted from 1991 to 2002.

Overall, about 15 percent of patients' hearts beat again on their own, but less than 5 percent survived long enough to be discharged from the hospital. For survivors, the average transit time was 4.0 minutes, not significantly different from the 4.2 minutes seen in non-survivors.

A few factors did improve survival, including having a witness to the cardiac arrest, CPR by a bystander, and quicker response time by emergency medical services.

An accompanying editorial suggests that the transport time may not matter, provided that the times are fairly short, as in the present study.

The current research "suggests that longer durations of transport for patients may be safe when transport intervals are relatively short," Dr. Jon C. Rittenberger and Dr. Clifton W. Callaway, from the University of Pittsburgh, write. "However, the risk of deterioration during the prolonged transports that may be required to reach regional centers still warrants further investigation."

SOURCE: Annals of Emergency Medicine, August 2009.