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Does care at a cardiac arrest centre improve outcome after out-of-hospital cardiac arrest? – A systematic review
Open accessAbstract
Aim To perform a systematic review to answer 'In adults with attempted resuscitation after non-traumatic cardiac arrest does care at a specialised cardiac arrest centre (CAC) compared to care in a healthcare facility not designated as a specialised cardiac arrest centre improve patient outcomes?' Methods The PRISMA guidelines were followed. We searched bibliographic databases (Embase, MEDLINE and the Cochrane Library (CENTRAL)) from inception to 1st August 2018. Randomised controlled trials (RCTs) and non-randomised studies were eligible for inclusion. Two reviewers independently scrutinized studies for relevance, extracted data and assessed quality of studies. Risk of bias of studies and quality of evidence were assessed using ROBINS-I tool and GRADEpro respectively. Primary outcomes were survival to 30 days with favourable neurological outcomes and survival to hospital discharge with favourable neurological outcomes. Secondary outcomes were survival to 30 days, survival to hospital discharge and return of spontaneous circulation (ROSC) post-hospital arrival for patients with ongoing resuscitation. This systematic review was registered in PROSPERO (CRD 42018093369) RESULTS: We included data from 17 observational studies on out-of-hospital cardiac arrest (OHCA) patients in meta-analyses. Overall, the certainty of evidence was very low. Pooling data from only adjusted analyses, care at CAC was not associated with increased likelihood of survival to 30 days with favourable neurological outcome (OR 2.92, 95% CI 0.68-12.48) and survival to 30 days (OR 2.14, 95% CI 0.73-6.29) compared to care at other hospitals. Whereas patients cared for at CACs had improved survival to hospital discharge with favourable neurological outcomes (OR 2.22, 95% CI 1.74-2.84) and survival to hospital discharge (OR 1.85, 95% CI 1.46-2.34). Conclusions Very low certainty of evidence suggests that post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge. There remains a need for high quality data to fully elucidate the impact of CACs.
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“A key concern is that respondents may be systematically different to non-respondents. 310”
From European Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions (2021) · cites this paper as [310]
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“The SPIIRT (Standard Protocol Items: Recommendations for Interventional Trials) PRO (Patient-reported outcome) extension guidelines provide information on including patient reported outcomes in clinical trials. 310”
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Self-citationEuropean Resuscitation Council Guidelines 2021: Ethics of resuscitation and end of life decisions
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“There is growing evidence that transportation to specialty hospitals is associated with improved outcomes, 65–67 although this may be limited to certain patient groups 68 and may not apply to all health care systems.”
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Erweiterte lebensrettende Maßnahmen für Erwachsene
Soar, J., Böttiger, B. W., Carli, P. A., Couper, K., Deakin, C. D., Djärv, T., Lott, C., Olasveengen, T. M., Paal, P., Pellis, T., et al. (2021) · Notfall + Rettungsmedizin · doi:10.1007/s10049-021-00893-x · Cited by 68
European Resuscitation Council Guidelines 2025 System Saving Lives
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Are there disparities in the location of automated external defibrillators in England?
Brown, T. P., Perkins, G. D., Smith, C. M., Deakin, C. D., & Fothergill, R. T. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.10.037 · Cited by 42
“66”
Ethik der Reanimation und Entscheidungen am Lebensende
Mentzelopoulos, S. D., Couper, K., de Voorde, P. V., Druwé, P., Blom, M. T., Perkins, G. D., Lulić, I., Djakow, J., Raffay, V. I., Lilja, G., et al. (2021) · Notfall + Rettungsmedizin · doi:10.1007/s10049-021-00888-8 · Cited by 32
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“Das ILCOR schlägt vor, dass erwachsene Patienten mit nichttraumatischem präklinischem Kreislaufstillstand nach Möglichkeit in Cardiac Arrest Zentren behandelt werden sollen [50, 250].”
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“2 Subsequently, the benefit of establishing CACs has been supported by further data.(3,4) Following these guidelines, in 2016, under the patronage of the German Resuscitation Council (GRC), a team of anesthesiologists, cardiologists, emergency medicine specialists and intensive care physicians in Germany initiated a D…”
BackgroundNolan, J. P., Sandroni, C., Böttiger, B. W., Cariou, A., Cronberg, T., Friberg, H., Genbrugge, C., Haywood, K. L., Lilja, G., Moulaert, V. R. M., et al. (2021) · Notfall + Rettungsmedizin · doi:10.1007/s10049-021-00892-y · Cited by 21
Self-citationEpidemiologie des Kreislaufstillstands in Europa
Gräsner, J., Herlitz, J. D., Tjelmeland, I. B. M., Wnent, J., Masterson, S., Lilja, G., Bein, B., Böttiger, B. W., Ortiz, F. R., Nolan, J. P., et al. (2021) · Notfall + Rettungsmedizin · doi:10.1007/s10049-021-00884-y · Cited by 21
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Resuscitation on the field of play: a best-practice guideline from Resuscitation Council UK
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“40 It is important that the field- of-play medical team liaise in advance with EMS and local hospital(s) to identify an appropriate receiving hospital, establish a prealert system, and, where necessary, protocols to allow bypass of hospitals that may be nearer but without these facilities.”
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Self-citationOut-of-hospital cardiac arrest outcomes in emergency departments
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“In recent systematic review and meta-analysis, direct transport of OHCA patients to CACs by EMS providers was associated with increased survival outcomes, despite very low certainty of evidence [8,9].”
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Substantial variation exists in post-cardiac arrest outcomes across Michigan hospitals
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“11–13 Previously, obtaining objective data about the quality of EMS resuscitation has been limited to retrospectively written patient care records; however, recent technological advances allow increased opportunity to use objective data collected in real time.”
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Rationale and Strategies for Development of an Optimal Bundle of Management for Cardiac Arrest
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“Numerous retrospective studies and several large systemic meta-reviews have demonstrated an association between treatment in a CAC and improved survival (at discharge or day 30) and/or better neurological results [80–86].”
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“For the first time, ERC and ESICM are emphasizing on the admission of patients with non-traumatic OHCA to a dedicated cardiac arrest center (CAC) [17].”
BackgroundOut-of-Hospital Cardiac Arrest
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Self-citationExtracorporeal CPR: Now a standard of care?
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“Endovascular 5 (10) Other (cooling device, mattress, paracetamol) 4 (8) Maintenance (n 1⁄4 51) Ice packs 20 (39) Cold fluid 13 (25) Cooling blankets 38 (75) Endovascular 6 (12) Other (cooling device, mattress) 3 (6)”
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“Some studies suggested that a higher level of care, including cardiac arrest centres, is associated to improved survival rates [31, 41, 42], while others claimed that the level of care is not an independent predictor of survival [31, 43].”
BackgroundDicker, B. L., Garrett, N., Howie, G., Brett, A., Scott, T., Stewart, R., Perkins, G. D., Smith, T., García‐Martín, E., & Todd, V. F. (2024) · Resuscitation Plus · doi:10.1016/j.resplu.2024.100625 · Cited by 6
“Although underpowered, this study is indicative of a possible survival benefit for cardiac arrest centres and is aligned with recent international literature reviews and meta-analysis that indicate a survival benefit for transport to a cardiac arrest centre [1,17,18].”
BackgroundResultHssain, A. A., Chalkias, A. F., Vahedian‐Azimi, A., Elmelliti, H., Alamami, A. A., Tawel, R., Morgom, M., Ullah, F. J., Arif, R., Mehmood, M., et al. (2024) · Intensive and Critical Care Nursing · doi:10.1016/j.iccn.2024.103889 · Cited by 6
Functional outcomes following an in-hospital cardiac arrest: A retrospective cohort study
Doherty, Z. B., Fletcher, J. A., Fuzzard, K. L., Leach, M. J., O'Sullivan, B. G., Panozzo, L., Pound, G. M., Saka, E., & Kippen, R. J. (2021) · Australian Critical Care · doi:10.1016/j.aucc.2021.07.002 · Cited by 6
Singapore Advanced Cardiac Life Support Guidelines 2021
Ching, C., Leong, B. S., Nair, P., Chan, K., Seow, E., Lee, F. C. Y., Heng, K. W. J., Sewa, D. W., Lim, T., Chong, D., et al. (2021) · Singapore Medical Journal · doi:10.11622/smedj.2021109 · Cited by 6
Tsuchida, T., Ono, K., Maekawa, K., Hayamizu, M., & Hayakawa, M. (2022) · BMC Emergency Medicine · doi:10.1186/s12873-022-00685-7 · Cited by 6
“One conclusion drawn today from low-quality data is that cardiac arrest centers may be associated with improved outcomes at discharge, but the certainty of that evidence is very low [18].”
BackgroundSimpson, R. F., Johnson, T., Rees, P. S. C., Glover, G. W., Sajjad, U., Fawaz, S., Khan, S. A., Beadle, E., Perilla, D., Maccaroni, M. R., et al. (2025) · Resuscitation · doi:10.1016/j.resuscitation.2025.110491 · Cited by 5
Cassina, T., Clivio, S., Putzu, A., Villa, M., Moccetti, T., Fortuna, D., & Casso, G. (2019) · Medicina Intensiva · doi:10.1016/j.medin.2019.05.006 · Cited by 5
Basic life support and systems saving lives
Olasveengen, T. M., & Semeraro, F. (2021) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000897 · Cited by 5
Pro: All Cardiac Arrest Patients Should Be Transferred To a Cardiac Arrest Center
Ursoleo, J. D., & Monaco, F. (2025) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2025.03.019 · Cited by 4
Kishihara, Y., Yasuda, H., Kashiura, M., Amagasa, S., Tamura, H., Shinzato, Y., & Moriya, T. (2025) · The Journal of Critical Care Medicine · doi:10.2478/jccm-2025-0016 · Cited by 4
“Patients with OHCA are heterogeneous, with diverse factors that may be associated with prognosis [2,3].”
Silwanis, C., Maier, J., Eder, J., Groche, M., Nahler, A., Fellner, A., Blessberger, H., Kellermair, J., Steinwender, C., & Lambert, T. (2025) · Resuscitation · doi:10.1016/j.resuscitation.2025.110763 · Cited by 4
Saviluoto, A., Jäntti, H., Holm, A., & Nurmi, J. O. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.03.023 · Cited by 4
Saeed, F., Murad, H., Wing, R. E., Li, J., Schold, J. D., & Fiscella, K. A. (2021) · Kidney Medicine · doi:10.1016/j.xkme.2021.08.014 · Cited by 4
“Additionally, the presence of a dedicated certified resuscitation team and postcardiac arrest care at a specialized tertiary care center like the Cleveland Clinic may have led to improved outcomes.(13) However, future studies are needed to address this question.”
BackgroundKishihara, Y., Kashiura, M., Yasuda, H., Kitamura, N., Nomura, T., Tagami, T., Yasunaga, H., Aso, S., Takeda, M., & Moriya, T. (2023) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2023.10.025 · Cited by 3
Ando, H., Sawano, M., Kohsaka, S., Ishii, H., Tajima, A., Suzuki, W., Kunimura, A., Nakano, Y., Kozuma, K., & Amano, T. (2024) · Resuscitation Plus · doi:10.1016/j.resplu.2024.100647 · Cited by 3
“These developments have contributed to an increase in the rate of successful discharge for critically ill patients who have experienced CA. 26–28 However, it is important to note that some of these patients may be discharged with a compromised neurological status, which can subsequently lead to…”
Resuscitation guideline highlights
Olasveengen, T. M., Ristagno, G., & Smyth, M. A. (2022) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000933 · Cited by 3
Stachel, G., Ruft, L., Hertenberger, N., Eichner, G., Lenk, K., Michalski, D., Claßen, J., Petros, S., Stehr, S. N., Laufs, U., et al. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.038688 · Cited by 3
“While a few retrospective analyses have demonstrated a considerable survival benefit of treat-ment at a CAC, 13,14 albeit with low certainty, a recent randomized trial could not detect a significant difference.”
No-Flow Duration and Outcomes After Cardiogenic Out-of-Hospital Cardiac Arrest in Older Adults
Kishihara, Y., Kashiura, M., Yasuda, H., Amagasa, S., 田村, 洋., Nakajima, C., Shiraoka, Y., Okubo, M., & Moriya, T. (2026) · JAMA Network Open · doi:10.1001/jamanetworkopen.2026.31343 · Cited by 2
Cardiac arrest centres: what, who, when, and where?
Ho, A. F. W., Yeo, J. W., & Ong, M. E. H. (2022) · Current Opinion in Critical Care · doi:10.1097/mcc.0000000000000934 · Cited by 2
Out-of-Hospital Cardiac Arrest
Gerecht, R. B., & Nable, J. V. (2024) · Cardiology Clinics · doi:10.1016/j.ccl.2024.02.014 · Cited by 2
Survival until hospital admission after out-of-hospital cardia arrest – A costly victory?
Skrifvars, M. B., & Prescott, R. J. (2020) · Resuscitation · doi:10.1016/j.resuscitation.2020.05.039 · Cited by 1
Self-citationAlrawashdeh, A., Al-Nusair, M., Rawashdeh, S., Abdi, D., Kheirallah, K. A., Alqahtani, S. M. M., Alwidyan, M., Oteir, A., Raffee, L. A., & Nehme, Z. (2025) · Resuscitation Plus · doi:10.1016/j.resplu.2025.100907 · Cited by 1
“9 Three clinical outcomes were described in this study for all events: ROSC, survival to hospital admission, and survival to hospital discharge.”
Patterson, T., Perkins, G. D., Dodd, M., Perkins, A., Mellett-Smith, A., Fothergill, R. T., Clayton, T. C., Evans, R., Robertson, S., Kwok, M., et al. (2025) · European Heart Journal Acute Cardiovascular Care · doi:10.1093/ehjacc/zuaf133 · Cited by 1
Kim, D., Park, H.-W., Kwon, H., Kim, S. M., Kim, J., Kim, Y., & Kim, W. Y. (2025) · Korean Circulation Journal · doi:10.4070/kcj.2025.0205 · Cited by 1
Young ERC Resuscitation Science Masterclass Journal Club article: the ARREST trial
Gallob, F., Bürgstein, E., & Jorge-Soto, C. (2026) · Resuscitation Plus · doi:10.1016/j.resplu.2026.101287 · Cited by 1
Kreutz, J., Betz, S., Hof, F., Markus, B., Mihali, K., Gruebl, T., Sassen, M. C., Schieffer, B., & Jerrentrup, A. (2026) · Resuscitation · doi:10.1016/j.resuscitation.2026.111264 · Cited by 1
Postreanimationsbehandlung – vom Erkennen des Spontankreislaufs zur Intensivmedizin
Metelmann, C., Katzenschlager, S., Roedl, K., Seewald, S., & Wnent, J. (2023) · Notfallmedizin up2date · doi:10.1055/a-2040-9978 · Cited by 1
“Geschieht dies, damit die Patient*innen eine bessere Therapie be-kommen können, die prähospital nicht verfügbar ist?”
Nursing core competencies for postresuscitation care in Iran: a qualitative study
Zali, M., Rahmani, A., Powers, K., Hassankhani, H., Areshtanab, H. N., & Gilani, N. (2024) · BMJ Open · doi:10.1136/bmjopen-2023-074614 · Cited by 1
Top cardiac arrest randomised trials of 2023
Scquizzato, T., Sandroni, C., Soar, J., & Nolan, J. P. (2024) · Resuscitation · doi:10.1016/j.resuscitation.2024.110133 · Cited by 1
Latsios, G., Sanidas, E. A., Velliou, M., Nikitas, G., Bounas, P., Parisis, C., Synetos, A. G., Toutouzas, K. P., & Tsioufis, C. P. (2025) · World Journal of Cardiology · doi:10.4330/wjc.v17.i1.100782 · Cited by 1
Babini, G., Cucino, A., Stirparo, G., Ristagno, G., Agostoni, C. V., & Cvetkovic, M. (2025) · Resuscitation Plus · doi:10.1016/j.resplu.2025.100970 · Cited by 1
“…gaps considered relevant to practitioners (emphasising the need for research to progress in alignment with clinical needs) and the interest in establishing a collaborative research program (all respondents demonstrated interest in creating a research network focused on pediatric CA and PCAC).”
Resuscitation highlights in 2019
Nolan, J. P., Ornato, J. P., Parr, M. J., Perkins, G. D., & Soar, J. (2020) · Resuscitation · doi:10.1016/j.resuscitation.2020.02.001 · Cited by 1
More supportive evidence for cardiac arrest centres
Yeung, J. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.12.013 · Cited by 1
“A systematic review and meta-analysis examined whether patients should be cared for in designated cardiac arrest centres (CACs) found very low certainty of evidence that supports post-cardiac arrest care at CACs is associated with improved outcomes at hospital discharge.[6] Significant knowledge gaps exist on how tran…”
BackgroundSelf-citationRandhawa, V. K., Kapur, N. K., & Hernández-Montfort, J. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.125.044052 · Cited by 1
Management of cardiac arrest in specialist centres
Fadhlillah, F., & Jia, W. (2019) · Resuscitation · doi:10.1016/j.resuscitation.2019.04.052
Reply to: Management of cardiac arrest in specialist centres
Yeung, J., Bray, J., & Skrifvars, M. B. (2019) · Resuscitation · doi:10.1016/j.resuscitation.2019.05.008
“Thank you for the opportunity to reply to Dr Fadhlillah and Dr Jia letter in response to our published review ‘Does care at a cardiac arrest centre improve outcome after out-of- hospital cardiac arrest?’[1]”
BackgroundSelf-citationBoriani, G. (2020) · European Journal of Internal Medicine · doi:10.1016/j.ejim.2020.01.014
The burden of comorbidity in resuscitated patients
Masterson, S., & Margey, R. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.07.029
Sinning, C., & Hassager, C. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.11.021
Triage of post-cardiac arrest patients: To PCI or not to PCI, that is the question
Nehme, Z., & Stub, D. A. (2021) · Resuscitation · doi:10.1016/j.resuscitation.2021.11.013
Predictors of Long-Term Survival after Cardiopulmonary Resuscitation
Nazarpour, P., Jafaraghaee, F., Moghadamnia, M. T., & Maroufizadeh, S. (2022) · Journal of Holistic Nursing and Midwifery · doi:10.32598/jhnm.32.2.2180
“In many countries, post-resuscitation care is not provided in specialized hospitals, and there are many differences between hospitals in terms of availability and type of post-resuscitation care as well as clinical outcomes [13].”
BackgroundCassina, T., Clivio, S., Putzu, A., Villa, M., Moccetti, T., Fortuna, D., & Casso, G. (2020) · Medicina Intensiva (English Edition) · doi:10.1016/j.medine.2019.05.015
Metadata
- Authors
- Yeung, J., Matsuyama, T., Bray, J., Reynolds, J., & Skrifvars, M. B.
- Affiliations
- University of Warwick (GB)
- Kyoto Prefectural University of Medicine (JP)
- Monash University (AU)
- Michigan State University (US)
- University of Helsinki (FI)
- Corresponding author
- Yeung, J.
- Venue
- Resuscitation
- Publisher
- Elsevier BV
- Published
- 2019-04
- Volume
- 137
- Pages
- 102-115
- ISSN
- 0300-9572 (ISSN-L)
- OpenAlex
- W2913395504
- Cited by
- 116
- References
- 71
- Citations by year
- 2026: 8 · 2025: 13 · 2024: 18 · 2023: 9 · 2022: 18 · 2021: 29 · 2020: 13 · 2019: 7
- FWCI
- 4.28
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Resuscitation (publishedVersion)
- Monash University Research Portal (Monash University) (publishedVersion, other-oa)
- PubMed (publishedVersion)
- Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
- Työväentutkimus Vuosikirja (submittedVersion)
- Warwick Research Archive Portal (University of Warwick) (submittedVersion)
- Funders
- American Heart Association
- Topics
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Mechanical Circulatory Support Devices
- Keywords
- out-of-hospital cardiac arrest, post-resuscitation care, neurological outcome, survival to hospital discharge, return of spontaneous circulation
- MeSH terms
- Adult, Cardiac Care Facilities, Humans, Survival Analysis, Cardiopulmonary Resuscitation, Out-of-Hospital Cardiac Arrest
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