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Aim  To assess whether the outcomes of out‐of‐hospital cardiac arrest ( OHCA ) differ between patients treated at tertiary or secondary emergency medical facilities.    Methods  Data from the Japanese Association for Acute Medicine Out‐of‐Hospital Cardiac Arrest ( JAAM ‐ OHCA ) registry between June 2014 and December 2015 were analyzed and compared between patients treated at tertiary (tertiary group) and secondary (secondary group) emergency medical facilities. The primary outcome of this study was a favorable neurological outcome at 1 and 3 months after  OHCA , defined as a Glasgow–Pittsburgh cerebral performance category of 1 or 2.    Results  Between June 2014 and December 2015, a total of 13,491 patients with  OHCA  were registered in the  JAAM ‐ OHCA  registry. Of these, 12,836 were eligible in the present analysis, with 11,583 in the tertiary group and 1,253 in the secondary group. The proportions of patients with favorable neurological outcomes in the tertiary group were significantly higher than those in the secondary group at 1 (4.7% versus 2.0%,  P  < 0.001) and 3 (3.5% versus 1.6%,  P  < 0.001) months after  OHCA . Even after adjusting for baseline characteristics of patients, treatment at a tertiary emergency medical facility was independently associated with favorable neurological outcomes at 1 (odds ratio, 2.856, 95% confidence interval, 1.429–5.710;  P  = 0.003) and 3 (odds ratio, 2.462, 95% confidence interval, 1.203–5.042;  P  = 0.014) months after  OHCA .    Conclusion  The neurological outcomes of patients with  OHCA  treated at tertiary emergency medical facilities were better than those of patients treated at secondary emergency medical facilities.

Impact of type of emergency department on the outcome of out‐of‐hospital cardiac arrest: a prospective cohort study