b'CARES 2023 Annual ReportSimilarly, Gottula et al. (2022) 10developed a GIS model to assess the eligibility of OHCA patients for extracorporeal cardiopulmonary resuscitation (ECPR) in the United States. By integrating data from CARES and the Resuscitation Outcomes Consortium dataset, the researchers were able to map the spatial distribution of ECPR candidates and assess their proximity to extracorporeal membrane oxygenation (ECMO)-ready centers (Figure 3). This mapping approach enabled them to visualize geographic disparities in ECPR eligibility and prioritize areas for improved access to ECPR services. The GIS model considered various factors such as transportation time to ECMO centers and the likelihood of prehospital ROSC to determine ECPR eligibility. After accounting for transportation time, the number of ECPR-eligible patients decreased significantly. The GIS model projects that approximately 2,500 lives could be saved over a span of seven years. This estimation is based on a 1.68% eligibility rate (9,889 out of 588,203 individuals) derived from the model for a 45-minute transportation time to a center equipped for ECMO and an assumed 25% survival rate to hospital discharge with favorable neurological outcomes. This highlights the importance of geographic factors in determining access to advanced cardiac care and the potential benefits of improving access to such care. Another study by Kragholm et al. (2017) 11addressed a gap in existing research by focusing on the impact of direct transport to percutaneous cardiac intervention (PCI) centers on outcomes for OHCA patients in North Carolina. Prior research has mostly focused on urbanFigure 3. Displays the 15-minute, 30-minute, and 45-minute drive time buffers around (A) ECMO-ready centers (B) ECMO-capable centers and areas with shorter travel times to medical facilities. The(C) PCI-capable centers in the U.S. existing guidelines do not have enough evidence to support the idea of bypass, especially in nonurban areas where transportation distances are longer. Using CARES data, researchers analyzed OHCA cases with prehospital ROSC from 2012 to 2014. Patients were categorized based on whether they were transported directly to a PCI center or a non-PCI facility, and outcomes were compared. Using the CARES State Coordinator as the honest broker, this study utilized ArcGIS 10.2 software to geocode each incident to a street-level address and calculate drive times to the destination hospital, nearest PCI center, and nearest non-PCI hospital. This method considered road network variables such as speed limits and one-way streets to accurately determine drive times. After adjusting for various factors, patients taken to PCI centers showed significantly higher rates of survival and favorable neurological outcomes compared to those taken to non-PCI hospitals. Findings remained consistent when employing instrumental variable methods, utilizing differential drive time (bypass time) as the instrumental variable, and adjusting for various factors including age, sex, EMS response time, initial rhythm, prehospital ECG information, and county clustering. The adjusted odds ratio (OR) for survival to hospital discharge and survival with favorable neurological outcome was 2.60 (95% CI, 1.295.22) and 2.24 (95% CI, 1.084.65), respectively. As depicted in Figure 4, across all drive time intervals (15, 610, 1120, 2130, and 30 minutes), patients transported to the nearest hospital with PCI-center status (N=486) and patients bypassing the nearest hospital to a PCI center (N=873) demonstrated improved adjusted survival and favorable neurological outcomes compared to those taken to non-PCI hospitals. Notably, even for patients bypassing the nearest non-PCI hospital to a PCI center with drive times exceeding 30 minutes (median drive time, 38.5 minutes [25%75%; 3446.5]), significant disparities in survival and favorable neurological outcomes persisted.52'