Centralizing Out-of-Hospital Cardiac Arrest Pathways for Patients in Wales, UK: Room for Improvement

Introduction: Out-of-hospital cardiac arrest (OHCA) is a time-critical emergency requiring rapid intervention. Updated national guidelines recommend transferring patients to hospitals with percutaneous coronary intervention (PCI) services, where feasible. Wales has established a framework to transfer patients with ST-elevation MI to PCI capable centres in 2012. This study evaluates whether treatment in PCI centres improves outcomes for OHCA patients admitted to intensive care units (ICUs) in Wales.


Methods: We conducted a retrospective cohort study using anonymised, linked electronic health records from the Secure Anonymised Information Linkage (SAIL) Databank. We linked data across emergency care, hospital admissions, intensive care units (ICUs), general practice (GP), demographic services, and national mortality records. Patients admitted to ICUs following OHCA between 2010 and 2023 were grouped by hospital type (PCI vs. non-PCI). Outcomes included in-hospital mortality, 30-day survival, and length of stay. Statistical analyses included age-sex standardised mortality ratios (SMRs), multivariate Cox regression, and Welch’s t-tests, adjusted for age, sex, deprivation, frailty, comorbidity, and APACHE II score.


Results: Between 2010 and 2022, there were 3328 ICU admissions for OHCA. Numbers increased from 125 to 345 annually. After 2012 approximately 60% of patients were admitted to PCI hospitals. Overall ICU mortality was 57%. Patient demographics were different, with older patients with higher APACHE II scores, women, patients from rural areas and lower socioeconomic status more represented in non-PCI hospitals. Adjusted analyses for these characteristics showed no statistically significant difference in mortality or survival between hospital types (HR 1.04, 95%CI 0.95-1.14). Furthermore, standardised mortality ratios, length of stay and time-to-death were not statistically different between PCI and non-PCI hospitals.


Conclusions: Despite centralisation of OHCA care to PCI centres, this study found no significant improvement in adjusted survival outcomes. There is a potential that centralisation has exacerbated health access inequality for traditionally vulnerable populations. Non-PCI hospitals showed comparative performance to PCI hospitals.