Variability in survival and post-cardiac arrest care following successful resuscitation from out-of-hospital cardiac arrest. (April 2019)

• Record Type: Journal Article
• Authors: Balian, Steve; Buckler, David G.; Blewer, Audrey L.; Bhardwaj, Abhishek; Abella, Benjamin S.
• Is Part Of: Resuscitation. Volume 137(2019)
• Page Start: 78
• Page End: 86
• Publication Date: 2019-04
• Subjects: Cardiac arrest -- Out-of-hospital -- Survival rate -- Coronary angiography -- Hypothermia -- Induced -- Epidemiology; Resuscitation -- Periodicals; Resuscitation -- Periodicals; Réanimation -- Périodiques; Electronic journals; 616.025
• DOI: 10.1016/j.resuscitation.2019.02.004
• Languages: English
• ISSNs: 0300-9572

Abstract

Abstract: Aim of the study: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. Methods: This retrospective study (2013–2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission. We compared post-arrest treatments across hospitals stratified into arrest volume quartiles. Logistic regression models were used to assess the volume-outcome relationship. Results: We analyzed 3512 OHCAs admitted to 48 hospitals. Survival to discharge (24–65%) and neurological recovery (15–56%) were highly varied between hospitals. Compared to lower performing hospitals, hospitals with higher survival rates (≥ 40%) performed significantly more coronary angiographies (32% vs. 26%), stenting (17.5% vs. 13%), and ICD placements (12.5% vs 7.4%). Across volume quartiles, no significant differences were found in percent of treatment provision or outcomes. After adjustment for patient demographics, prehospital and post-arrest care variables, odds of survival and neurological recovery were 43% (OR 1.43; 95% CI, 1.08–1.89) and 51% (OR 1.51; 95% CI, 1.11–2.04) higher in hospitals with greater receiving volumes, respectively. Conclusions: Hospital case volume is associated with improved patient outcomes. Inter-hospital variability in OHCA outcomes may potentially be addressed by regionalization of care to high volume centers with higher rates of post-arrest care provision and better patient outcomes.