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Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

1. Abstract We are reporting a series of 3 cases of foreign shipyard workers who have been in Singapore for less than a year and presented with similar clinical features of pneumonia from Streptococcus pneumonia. These patients came in within a span of 3 months from April to June and all 3 were referred early by General Practitioners (GP). Despite the recent advances in antibiotic therapy and ventilating equipment, community acquired pneumonia remains a common cause for hospitalization and intubation for type one respiratory failure. A study done in 1993 by Hui [1] in National University Hospital of Singapore reported an incidence 12 % of Streptococcus pneumoniae for non-tuberculous pneumonia. Two of the three patients had positive blood cultures from Streptococcal pneumonia and one had positive urine Streptococcal antigen tests. All 3 presented with hypotension and hypoxia on arrival in the Emergency Department(ED) and despite fluid resuscitation and oxygen therapy, 2 of them ended up with severe hypoxia requiring intubation. All 3 ended up with noradrenaline inotropic infusion for at least 24 hours. All three patients responded to treatment and recovered fully. They were all subsequently discharged from the hospital. There is a postulation that Pneumococcal vaccine could have prevented the infection and the subsequent complication related to the infection in these foreign shipyard workers though there is not enough data to suggest so. The current data is based on studies in young children and elderly patients [2,3] .