Helicopter vs. ground transport: outcomes of out-of-hospital cardiac arrest patients with intra-arrest transport

OBJECTIVE: Deciding to transport a patient intra-arrest is difficult. The effect of the mode of transportation, either helicopter emergency medical services (HEMS) or ground emergency medical services (GEMS) and its potential link to neurological outcomes has not yet been assessed. METHODS: We performed a retrospective cohort study using data from our Cardiac Arrest Registry. Adult out-of-hospital cardiac arrest (OHCA) patients transported intra-arrest were included. Neurological outcome at 6 months, measured using the cerebral performance category (CPC 1-2: good, CPC 3-5: poor), served as the primary endpoint. Associations between mode of transport and prehospital time with neurological outcome were examined using univariable and multivariable logistic regression. RESULTS: We included 639 patients of whom 533 (83%) were transported by GEMS and 106 (17%) by HEMS. Patients transported by HEMS were younger (median age 54 years vs. 58 years) and more frequently had witnessed arrest and a shockable initial rhythm (55% vs. 42%). Median prehospital time did not differ significantly between groups (HEMS: 62 min, GEMS: 58 min). In univariable and multivariable analyses, the transport mode was not associated with a favorable neurological outcome at 6 months (p > 0.4). Neurological outcome was independently associated with arrest-related factors, including age, witnessed arrest, initial rhythm and cumulative adrenaline dose. CONCLUSION: For patients undergoing intra-arrest transport, the mode of transport (HEMS vs. GEMS) was not significantly associated with neurological outcomes at 6 months. Neurological results appeared to be more influenced by arrest-related factors than by the transport method in this cohort.