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Cardiac Arrest During Interfacility Transport with Emergency Medical Services: A Preliminary Nationwide
Gregory A Peters1, Anjali J Misra1, Kian D Samadian1
1Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Prehospital Emergency Care
|June 16, 2026
Summary
Higher levels of emergency medical services (EMS) care during interfacility transport (IFT) are linked to better outcomes for out-of-hospital cardiac arrests (OHCA). Critical care transport (CCT) showed superior results, emphasizing the need for proper patient triage.
Area of Science:
- Emergency Medicine
- Cardiology
- Public Health
Background:
- Out-of-hospital cardiac arrests (OHCA) during interfacility transport (IFT) are a critical event.
- Limited national data exists on OHCA occurring during EMS-provided IFT.
Purpose of the Study:
- To conduct the first national study on OHCA witnessed by emergency medical services (EMS) during IFT.
- To analyze factors associated with return of spontaneous circulation (ROSC) during IFT.
Main Methods:
- Cross-sectional observational study using a 2023 nationwide prehospital patient care report dataset.
- Analysis of 1,466 OHCA incidents during IFT, stratified by EMS care level (BLS, ALS, CCT).
- Multivariable logistic regression to identify factors associated with ROSC, including initial rhythm and transport mode.
Main Results:
- 50.3% of patients achieved ROSC by the end of the IFT encounter.
- Higher EMS care levels (ALS, CCT) and shockable rhythms were associated with better ROSC.
- Geriatric age, BLS care, and ground transport were associated with worse outcomes.
Conclusions:
- Higher levels of EMS care during IFT are associated with improved short-term outcomes for OHCA patients.
- Critical Care Transport (CCT) demonstrated superior outcomes, particularly for patients with unshockable rhythms.
- Findings highlight the importance of accurate patient triage and the value of CCT for high-risk patients during IFT.
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