Variability in survival and post-cardiac arrest care following successful resuscitation from out-of-hospital cardiac arrest

Steve Balian; David G Buckler; Audrey L Blewer; Abhishek Bhardwaj; Benjamin S Abella; CARES Surveillance Group

doi:10.1016/j.resuscitation.2019.02.004

Variability in survival and post-cardiac arrest care following successful resuscitation from out-of-hospital cardiac arrest

Resuscitation. 2019 Apr:137:78-86. doi: 10.1016/j.resuscitation.2019.02.004. Epub 2019 Feb 13.

Authors

Steve Balian¹, David G Buckler¹, Audrey L Blewer², Abhishek Bhardwaj¹, Benjamin S Abella³; CARES Surveillance Group

Affiliations

¹ Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Community and Family Medicine, Duke University School of Medicine, NV, USA.
³ Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: benjamin.abella@uphs.upenn.edu.

PMID: 30771450
DOI: 10.1016/j.resuscitation.2019.02.004

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.

Keywords: Cardiac arrest; Coronary angiography; Epidemiology; Hypothermia; Induced; Out-of-hospital; Survival rate.

MeSH terms

Cardiopulmonary Resuscitation*
Female
Hospital Mortality
Hospitals / statistics & numerical data*
Humans
Male
Middle Aged
Out-of-Hospital Cardiac Arrest / mortality*
Out-of-Hospital Cardiac Arrest / therapy*
Patient Discharge
Pennsylvania
Registries
Retrospective Studies
Survival Rate