Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan.
Acute medicine & surgery · 2025-01-01 · Registry study
Abstract
AIM: In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan. METHODS: In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes. RESULTS: Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86-0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8-4.4). CONCLUSION: A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.