Cardiac arrest centres: what, who, when, and where?

Area of Science:

• Cardiology
• Emergency Medicine
• Critical Care

Background:

• Cardiac arrest centres (CACs) are crucial for postresuscitation care in out-of-hospital cardiac arrest (OHCA).
• Existing research highlights the benefits of regionalizing care within CACs.
• There is a lack of consensus on standardized CAC definitions and optimal transport strategies.

Purpose of the Study:

• To provide an updated overview of Cardiac Arrest Centres (CACs).
• To identify evidence gaps and future research directions for CACs and OHCA care.
• To review current definitions and transport strategies for CACs.

Main Methods:

• Review of existing literature on Cardiac Arrest Centres (CACs).
• Analysis of meta-analyses demonstrating the benefits of CACs.
• Identification of areas lacking robust evidence, particularly transport strategies.

Main Results:

• CACs typically offer 24/7 percutaneous coronary intervention, targeted temperature management, neuroprognostication, and intensive care.
• Meta-analyses show improved survival and neurological outcomes for OHCA patients transported to CACs.
• Evidence is scarce regarding optimal patient selection ('who'), timing ('when'), and destination ('where') for CAC transport, especially for non-ST elevation OHCA.

Conclusions:

• CACs significantly improve outcomes for OHCA patients, particularly those with shockable rhythms or ST-elevation myocardial infarction.
• Further real-world studies are needed to define optimal CAC transport strategies.
• Future research should focus on randomized controlled trials evaluating specific transport protocols, including bypassing nearest facilities.