Impact of establishing a new emergency and critical care center on regional out-of-hospital cardiac arrest transport patterns and outcomes

Background: Out-of-hospital cardiac arrest (OHCA) outcomes are influenced by prehospital- and hospital-level factors. Transport to tertiary-level emergency and critical care centers (ECCCs) offering comprehensive post-cardiac arrest management improves survival; however, regional disparities exist. This study aimed to evaluate how establishing a new ECCC affects OHCA transport patterns and outcomes. Methods: We conducted a study of 1497 patients with OHCA treated between 2019 and 2020 (pre-establishment) and between 2022 and 2023 (post-ECCC establishment) in a single regional emergency medical services system. Multinomial logistic regression was used to assess the association between transport distance and hospital destination, and multivariate logistic regression was used to identify factors associated with transport to the new ECCC. Subgroup analyses examined the return of spontaneous circulation (ROSC), 1-month survival, and favorable neurological outcomes (Cerebral Performance Category 1-2) in patients aged ≥65 years. Results: After ECCC establishment, direct transport to the new ECCC increased across all distances, whereas transfers to secondary hospitals declined. Older patients (≥65 years) were more likely to be transported to the new ECCC, whereas traumatic cases were directed to pre-existing ECCCs (including trauma centers). ROSC at hospital arrival improved among older patients, but 1-month survival and favorable neurological outcomes did not significantly change. Conclusions: The establishment of a new ECCC redistributed regional OHCA transport and improved access to ECCC care. Although ROSC improved in patients aged ≥65 years, this did not translate into better long-term or neurological outcomes, underscoring the need for optimized resuscitation strategies in aging populations.