(HealthDay News) – Following implementation of the fifth link (multidisciplinary postresuscitation care in a regional center) to the previous four links in the chain of survival concept improves neurological outcomes for patients with out-of-hospital cardiac arrest, according to a study published in the July 31 issue of Circulation.

Takashi Tagami, MD, PhD, from the Nippon Medical School in Tokyo, and colleagues conducted a multicenter, prospective cohort study involving all eligible out-of-hospital cardiac arrest patients from the Aizu region of Japan (1,482 patients). The proportion with a favorable neurological outcome was assessed before and after implementation of the fifth link (January 2006–April 2008 and January 2009–December 2010, respectively).

The researchers found that, after implementation, following restoration of circulation, all patients were transported directly from the field or from an outlying hospital to a tertiary-level hospital, where they received intensive postresuscitation care. After implementation the one-month survival with a favorable neurological outcome among all patients treated by emergency medical services providers improved significantly, from 0.5% to 3%. Favorable neurological outcome had an adjusted odds ratio of 0.9 (95% confidence interval, 0.7–1.1) for early access to emergency medical care, 3.1 for bystander resuscitation, 14.7 for early defibrillation, 1 for early advanced life support, and 7.8 for the fifth link.

“The proportion of out-of-hospital cardiac arrest patients with a favorable neurological outcome improved significantly after the implementation of the fifth link, which may be an independent predictor of outcome,” the authors write.

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