Association between destination hospital level and outcomes in out-of-hospital cardiac arrest patients under a dispatch-guided transport system: a population-based study in Nagoya, Japan.

BACKGROUND

The relationship between destination hospital level and outcomes in out-of-hospital cardiac arrest (OHCA) patients remains controversial. To examine the association between transport to critical care medical centers and outcomes, we analyzed all city-wide data from Nagoya City, where the initial hospital request is made without consideration of initial cardiac rhythm.

METHODS

This retrospective cohort study included 12,663 OHCA patients in Nagoya City between April 2019 and March 2025. Patients were classified by destination hospital: critical care medical center (n = 11,149) or other hospital (n = 1514). Favorable one-month neurological outcomes and one-month survival were evaluated. Inverse probability of treatment weighting (IPTW) evaluated associations between destination hospital level and outcomes. Refractory shockable rhythm was explored.

RESULTS

In the critical care medical center and other hospital groups, favorable one-month neurological outcome rates were 1.9% versus 1.7% (P = 0.683), and survival rates were 4.1% versus 4.5% (P = 0.494). IPTW showed no association between destination hospital level and favorable neurological outcomes overall or by rhythm. Transport to critical care medical centers was associated with lower one-month survival in patients with non-shockable rhythm (odds ratio, 0.66; 95% confidence interval, 0.46-0.95). Exploratory analysis showed higher one-month survival among patients with refractory shockable rhythm transported to critical care medical centers (19.7% vs. 3.3%), although the estimate was imprecise.

CONCLUSION

Under a dispatch-guided transport system, transport to critical care medical centers was not associated with favorable neurological outcomes in either rhythm group. These findings do not establish a preferred transport strategy, although selected patients may have better outcomes at these centers.