25th November 2024

Editor-in-Chief,

Minerva Cardiology and Angiology

Dear Editor,

We are submitting our manuscript titled “Comparing Outcomes of Transport to Cardiac Arrest Centers versus Non-Cardiac Arrest Centers
after Out-of-Hospital Cardiac Arrest: An Updated Systematic Review and Meta-Analysis” for consideration of publication in Minerva
Cardiology and Angiology.

The significance of this manuscript lies in its comprehensive evaluation of the impact of transport to Cardiac Arrest Centers (CACs) versus non-
CACs on outcomes following out-of-hospital cardiac arrest (OHCA). As OHCA remains a leading cause of mortality with a low survival rate,
identifying optimal transport strategies is crucial for improving patient outcomes. Our updated systematic review and meta-analysis, encompassing
37 studies and over 244,000 patients, reveal that direct transport to CACs significantly enhances survival rates and neurological outcomes
compared to non-CACs. This finding is particularly pertinent for guiding emergency medical services and healthcare policies, as it underscores the
benefits of specialized centers equipped to manage complex post-resuscitation care. The results not only reinforce previous evidence on the
advantages of CACs but also address gaps in current guidelines and provide new insights into optimizing transport strategies for various patient
subgroups. By highlighting these critical differences, our study aims to inform clinical practice and contribute to improved protocols in the
management of OHCA patients. We believe that our article will be of interest to the broad audience of Minerva Cardiology and Angiology.

The manuscript represents original work that has not been published elsewhere and is not under consideration for publication in any other journal.
Instructions to the authors were read. We accept all conditions and publication rights. We have no funding sources to declare. The authors of this
manuscript collectively affirm that each individual has made substantial contributions to all aspects of the work. This includes the conception and
design of the study, acquisition of data, and analysis and interpretation of the data. Furthermore, all authors have been involved in drafting the
article or revising it critically for significant intellectual content. Each author has provided final approval of the version to be submitted and has
agreed to be accountable for all aspects of the work, ensuring the integrity and accuracy of the research presented.

We have no conflict of interests to declare.

Thank you,
Yours sincerely,

Aqsa Shoaib, MBBS Karachi Medical and Dental College,

Block M North Nazimabad, Karachi, Sindh 74700, Pakistan.
Email: [email protected]

PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)

Checklist
www.prisma-statement.org
You must report the page number in your manuscript where you consider each of the items listed in this checklist. If you have not included this information,
either revise your manuscript accordingly before submitting or note N/A.

Item Reported on
Section/Topic No. Checklist item Page No.

TITLE
Title 1 Identify the report as a systematic review, meta-analysis, or both. 1
ABSTRACT
Structured 2 Provide a structured summary including, as applicable: background; objectives; data sources; study eligibility 2
summary criteria, participants, and interventions; study appraisal and synthesis methods; results; limitations; conclusions
and implications of key findings; systematic review registration number.
INTRODUCTION
Rationale 3 Describe the rationale for the review in the context of what is already known. 3
Objectives 4 Provide an explicit statement of questions being addressed with reference to participants, interventions, 4
comparisons, outcomes, and study design (PICOS).
METHODS
Protocol and 5 Indicate if a review protocol exists, if and where it can be accessed (e.g., Web address), and, if available, provide 1
registration registration information including registration number.
Eligibility criteria 6 Specify study characteristics (e.g., PICOS, length of follow-up) and report characteristics (e.g., years considered, 5
language, publication status) used as criteria for eligibility, giving rationale.
Information 7 Describe all information sources (e.g., databases with dates of coverage, contact with study authors to identify 4
sources additional studies) in the search and date last searched.
Search 8 Present full electronic search strategy for at least one database, including any limits used, such that it could be 5
repeated.
Study selection 9 State the process for selecting studies (i.e., screening, eligibility, included in systematic review, and, if applicable, 5,6
included in the meta-analysis).
Data collection 10 Describe method of data extraction from reports (e.g., piloted forms, independently, in duplicate) and any 4
process processes for obtaining and confirming data from investigators.
Data items 11 List and define all variables for which data were sought (e.g., PICOS, funding sources) and any assumptions and 4
simplifications made.
Risk of bias in 12 Describe methods used for assessing risk of bias of individual studies (including specification of whether this was 5
individual studies done at the study or outcome level), and how this information is to be used in any data synthesis.

Item Reported on
Section/Topic No. Checklist item Page No.

Summary 13 State the principal summary measures (e.g., risk ratio, difference in means). 6
measures
Synthesis of 14 Describe the methods of handling data and combining results of studies, if done, including measures of 6
results consistency (e.g., I2) for each meta-analysis.
Risk of bias across 15 Specify any assessment of risk of bias that may affect the cumulative evidence (e.g., publication bias, selective 5
studies reporting within studies).
Additional 16 Describe methods of additional analyses (e.g., sensitivity or subgroup analyses, meta-regression), if done, 6
analyses indicating which were pre-specified.

RESULTS
Study selection 17 Give numbers of studies screened, assessed for eligibility, and included in the review, with reasons for 7
exclusions at each stage, ideally with a flow diagram.
Study 18 For each study, present characteristics for which data were extracted (e.g., study size, PICOS, follow-up period) 8
characteristics and provide the citations.
Risk of bias within 19 Present data on risk of bias of each study and, if available, any outcome level assessment (see item 12). 11
studies
Results of 20 For all outcomes considered (benefits or harms), present, for each study: (a) simple summary data for each 8,9,10
individual studies intervention group (b) effect estimates and confidence intervals, ideally with a forest plot.
Synthesis of 21 Present results of each meta-analysis done, including confidence intervals and measures of consistency. 8,9,10
results
Risk of bias across 22 Present results of any assessment of risk of bias across studies (see Item 15). 11
studies
Additional analysis 23 Give results of additional analyses, if done (e.g., sensitivity or subgroup analyses, meta-regression [see Item 16]). 9,10

DISCUSSION

Summary of 24 Summarize the main findings including the strength of evidence for each main outcome; consider their 11
evidence relevance to key groups (e.g., healthcare providers, users, and policy makers).
Limitations 25 Discuss limitations at study and outcome level (e.g., risk of bias), and at review-level (e.g., incomplete retrieval 15
of identified research, reporting bias).
Conclusions 26 Provide a general interpretation of the results in the context of other evidence, and implications for future 16
research.

FUNDING

Item Reported on
Section/Topic No. Checklist item Page No.

Funding 27 Describe sources of funding for the systematic review and other support (e.g., supply of data); role of funders N/A
for the systematic review.

From: Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA
Statement. PLoS
Med 6(6): e1000097. doi:10.1371/journal.pmed1000097

Once you have completed this checklist, please save a copy and upload it as part of your submission. Please DO NOT include this checklist as part of the
main manuscript document. It must be uploaded as a separate file.