Difficult-to-transport Cases and Neurological Outcomes of Out-of-hospital Cardiac Arrest: A Population-based Nationwide Study in Japan

Overview

Journal Acute Med Surg

Specialty Critical Care

Date 2025 Mar 5

PMID 40041116

Authors

Azusa Taguchi

Shotaro Aso

Hiroshi Yamagami

Hideo Yasunaga

Affiliations

Soon will be listed here.

Abstract

Aim: In Japan, emergency medical service personnel often have difficulty obtaining hospitals' acceptance of emergency cases owing to congestion in the emergency unit; such cases are called difficult-to-transport cases. Increased difficult-to-transport cases at a regional level may be associated with the prognosis of out-of-hospital cardiac arrest (OHCA). This study aimed to investigate the association between the proportion of difficult-to-transport cases at a regional level and neurological outcomes in patients with OHCA, using the nationwide Utstein database linked to ambulance records in Japan.

Methods: In this retrospective cohort study from 2017 to 2021 in Japan, the proportion of difficult-to-transport cases was calculated as the number of difficult-to-transport cases divided by the number of emergency calls in each district on each day. Patients with OHCA were categorized into no, low, and high difficult-to-transport cases groups. The primary outcome was a Cerebral Performance Category 1 or 2 at 1 month. The secondary outcome was transportation time intervals. Multivariate regression analyses were conducted to assess the association between difficult-to-transport cases and patient outcomes.

Results: Among 592,021 eligible patients, the no, low, and high difficult-to-transport case groups included 282,747 (48%), 155,167 (26%), and 154,107 (26%) patients, respectively. The high difficult-to-transport cases group was associated with decreased favorable neurological outcomes (adjusted odds ratio, 0.91; 95% confidence interval, 0.86-0.95) and longer total transportation time (difference, 4.1 min; 95% confidence interval, 3.8-4.4).

Conclusion: A higher proportion of difficult-to-transport cases was associated with poorer neurological outcomes and longer total transportation times in patients with OHCA.

Citing Articles

Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan.

Taguchi A, Aso S, Yamagami H, Yasunaga H Acute Med Surg. 2025; 12(1):e70050.

PMID: 40041116 PMC: 11876083. DOI: 10.1002/ams2.70050.

References

Hanaki N, Yamashita K, Kunisawa S, Imanaka Y . Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan. BMJ Open. 2016; 6(12):e012194. PMC: 5168703. DOI: 10.1136/bmjopen-2016-012194. View

Prezant D, Lancet E, Zeig-Owens R, Lai P, Appel D, Webber M . System impacts of the COVID-19 pandemic on New York City's emergency medical services. J Am Coll Emerg Physicians Open. 2021; 1(6):1205-1213. PMC: 7771735. DOI: 10.1002/emp2.12301. View

Greenland S . Avoiding power loss associated with categorization and ordinal scores in dose-response and trend analysis. Epidemiology. 1995; 6(4):450-4. DOI: 10.1097/00001648-199507000-00025. View

Higashi H, Takaku R, Yamaoka A, Lefor A, Shiga T . The Dedicated Emergency Physician Model of emergency care is associated with reduced pre-hospital transportation time: A retrospective study with a nationwide database in Japan. PLoS One. 2019; 14(4):e0215231. PMC: 6467406. DOI: 10.1371/journal.pone.0215231. View

Greenland S . Dose-response and trend analysis in epidemiology: alternatives to categorical analysis. Epidemiology. 1995; 6(4):356-65. DOI: 10.1097/00001648-199507000-00005. View

Matsuyama T, Kitamura T, Katayama Y, Kiyohara K, Hayashida S, Kawamura T . Factors associated with the difficulty in hospital acceptance among elderly emergency patients: A population-based study in Osaka City, Japan. Geriatr Gerontol Int. 2017; 17(12):2441-2448. DOI: 10.1111/ggi.13098. View

Hori S . Emergency medicine in Japan. Keio J Med. 2010; 59(4):131-9. DOI: 10.2302/kjm.59.131. View

Alanazy A, Wark S, Fraser J, Nagle A . Factors Impacting Patient Outcomes Associated with Use of Emergency Medical Services Operating in Urban Versus Rural Areas: A Systematic Review. Int J Environ Res Public Health. 2019; 16(10). PMC: 6572626. DOI: 10.3390/ijerph16101728. View

Taguchi A, Aso S, Yamagami H, Yasunaga H . Difficult-to-transport cases and neurological outcomes of out-of-hospital cardiac arrest: A population-based nationwide study in Japan. Acute Med Surg. 2025; 12(1):e70050. PMC: 11876083. DOI: 10.1002/ams2.70050. View

10.

Katayama Y, Kitamura T, Kiyohara K, Iwami T, Kawamura T, Izawa J . Improvements in Patient Acceptance by Hospitals Following the Introduction of a Smartphone App for the Emergency Medical Service System: A Population-Based Before-and-After Observational Study in Osaka City, Japan. JMIR Mhealth Uhealth. 2017; 5(9):e134. PMC: 5616023. DOI: 10.2196/mhealth.8296. View

11.

Ushimoto T, Yao S, Nunokawa C, Murasaka K, Inaba H . Association between the COVID-19 pandemic in 2020 and out-of-hospital cardiac arrest outcomes and bystander resuscitation efforts for working-age individuals in Japan: a nationwide observational and epidemiological analysis. Emerg Med J. 2023; 40(8):556-563. PMC: 10423471. DOI: 10.1136/emermed-2022-213001. View

12.

Uy-Evanado A, Chugh H, Sargsyan A, Nakamura K, Mariani R, Hadduck K . Out-of-Hospital Cardiac Arrest Response and Outcomes During the COVID-19 Pandemic. JACC Clin Electrophysiol. 2021; 7(1):6-11. PMC: 7428321. DOI: 10.1016/j.jacep.2020.08.010. View

13.

Shen Y, Hsia R . Association between ambulance diversion and survival among patients with acute myocardial infarction. JAMA. 2011; 305(23):2440-7. PMC: 4109302. DOI: 10.1001/jama.2011.811. View

14.

Kitamura T, Iwami T, Kawamura T, Nagao K, Tanaka H, Hiraide A . Nationwide public-access defibrillation in Japan. N Engl J Med. 2010; 362(11):994-1004. DOI: 10.1056/NEJMoa0906644. View

15.

Igarashi Y, Yabuki M, Norii T, Yokobori S, Yokota H . Quantitative analysis of the impact of COVID-19 on the emergency medical services system in Tokyo. Acute Med Surg. 2021; 8(1):e709. PMC: 8604116. DOI: 10.1002/ams2.709. View

16.

Katasako A, Yoshikawa Y, Noguchi T, Ogata S, Nishimura K, Tsujita K . Changes in neurological outcomes of out-of-hospital cardiac arrest during the COVID-19 pandemic in Japan: a population-based nationwide observational study. Lancet Reg Health West Pac. 2023; :100771. PMC: 10152207. DOI: 10.1016/j.lanwpc.2023.100771. View

17.

Jena A, Mann N, Wedlund L, Olenski A . Delays in Emergency Care and Mortality during Major U.S. Marathons. N Engl J Med. 2017; 376(15):1441-1450. PMC: 5558156. DOI: 10.1056/NEJMsa1614073. View

18.

Yasunaga H, Horiguchi H, Tanabe S, Akahane M, Ogawa T, Koike S . Collaborative effects of bystander-initiated cardiopulmonary resuscitation and prehospital advanced cardiac life support by physicians on survival of out-of-hospital cardiac arrest: a nationwide population-based observational study. Crit Care. 2010; 14(6):R199. PMC: 3219985. DOI: 10.1186/cc9319. View

19.

Yu J, Liu C, Chen W, Yu S, Huang F, Yang M . Impact of the COVID-19 pandemic on emergency medical service response to out-of-hospital cardiac arrests in Taiwan: a retrospective observational study. Emerg Med J. 2021; 38(9):679-684. PMC: 8282423. DOI: 10.1136/emermed-2020-210409. View

20.

Yamada K, Inoue S, Sakamoto Y . An effective support system of emergency medical services with tablet computers. JMIR Mhealth Uhealth. 2015; 3(1):e23. PMC: 4376173. DOI: 10.2196/mhealth.3293. View