While there is not a straight forward answer to this question, most of the studies published to date have reported transport times less than 10 minutes from the scene. Transport time in the reported studies did not take into account time at the scene or time from dispatch. However, it would make sense that the longer the patient has been down, the smaller the chance of survival, versus a patient that had an arrest witnessed by EMS.

Bypassing a local, minimal-capability hospital might be the correct step for EMS to take if they can transport the OOHCA patient to a more specialized facility that offers cardiac catheterization and invasive cardiac procedures, even if the transport time is longer. However, this could be different in rural prehospital systems where transport times are much greater than ten minutes.

References

1. Neumar RW, Shuster M, Callaway CW, et al. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132(suppl 2):S315-S367.
2. Kronick ST, Kurz MC, Lin S, et al. Systems of care and continuous quality improvement. 2015 American Heart Association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2015;132:S397-S413.
3. Jabbour RJ, Sen S, Mikhail GW, et al. Out of hospital cardiac arrest: concise review of strategies to improve outcome. Cardiovasc Revasc Med. March 15, 2017. [Epub ahead of print]
4. Cha WC, Lee SC, Shin SD, et al. Regionalisation of out of hospital cardiac arrest for patients without prehospital return of spontaneous circulation. Resuscitation. 2012;83:1338-1342.
5. Geri G, Gilga J, Wu W, et al. Does transport time of out of hospital cardiac arrest patients matter? A systematic review and meta-analysis. Resuscitation. 2017;115:96-101.
6. Spaite DW, Stiell IG, Bobrow BJ, et al. Effect of transport interval on out of hospital cardiac arrest siurvival in the OPLAS study: implications for triaging patients to specialized cardiac arrest centers. Ann Emeg Med. 2009;54(2):248-255.
7. Cudnik, MT, Schmicker RH, Vaillancourt C, et al. A geospatial assessment of transport distance and survival to discharge in out of hospital cardiac arrest patients: implications for resuscitation centers. Resuscitation. 2010;81(5):518-523.
8. Tranber T, Lippert FK, Christense EF, et al. Distance to invasive heart centre, performance of acute coronary angiography, and angioplasty and associated outcome in out of hospital cardiac arrest: a nationwide study. Eur Heart J. 2017;00:1-8.
9. Cheskes, S, Byeres A, Zhan C, et al. CPR quality during out of hospital cardiac arrest transport. Resuscitation. 2017;114:34-39.

Dr. Lipe is a captain in the Medical Corps of the U.S. Army and a physician in the emergency department at Martin Army Community Hospital in Fort Benning, Georgia.