Relationship Between Institutional Volume of Out-of-Hospital Cardiac Arrest Cases and 1-Month Neurologic Outcomes: A Post Hoc Analysis of a Prospective Observational Study

Masahiro Kashiura; Shunsuke Amagasa; Takashi Moriya; Atsushi Sakurai; Nobuya Kitamura; Takashi Tagami; Munekazu Takeda; Yasufumi Miyake; SOS-KANTO 2012 Study Group

doi:10.1016/j.jemermed.2020.04.039

Relationship Between Institutional Volume of Out-of-Hospital Cardiac Arrest Cases and 1-Month Neurologic Outcomes: A Post Hoc Analysis of a Prospective Observational Study

J Emerg Med. 2020 Aug;59(2):227-237. doi: 10.1016/j.jemermed.2020.04.039. Epub 2020 May 25.

Authors

Masahiro Kashiura¹, Shunsuke Amagasa¹, Takashi Moriya¹, Atsushi Sakurai², Nobuya Kitamura³, Takashi Tagami⁴, Munekazu Takeda⁵, Yasufumi Miyake⁶; SOS-KANTO 2012 Study Group

Collaborators

SOS-KANTO 2012 Study Group:
Sadaki Inokuchi, Yoshihiro Masui, Kunihisa Miura, Haruhiko Tsutsumi, Kiyotsugu Takuma, Ishihara Atsushi, Minoru Nakano, Hiroshi Tanaka, Keiichi Ikegami, Takao Arai, Arino Yaguchi, Nobuya Kitamura, Shigeto Oda, Kenji Kobayashi, Takayuki Suda, Kazuyuki Ono, Naoto Morimura, Ryosuke Furuya, Yuichi Koido, Fumiaki Iwase, Ken Nagao, Shigeru Kanesaka, Yasusei Okada, Kyoko Unemoto, Tomohito Sadahiro, Masayuki Iyanaga, Asaki Muraoka, Munehiro Hayashi, Shinichi Ishimatsu, Yasufumi Miyake, Hideo Yokokawa, Yasuaki Koyama, Asuka Tsuchiya, Tetsuya Kashiyama, Munetaka Hayashi, Kiyohiro Oshima, Kazuya Kiyota, Yuichi Hamabe, Hiroyuki Yokota, Shingo Hori, Shin Inaba, Tetsuya Sakamoto, Naoshige Harada, Akio Kimura, Masayuki Kanai, Yasuhiro Otomo, Manabu Sugita, Kosaku Kinoshita, Takatoshi Sakurai, Mitsuhide Kitano, Kiyoshi F B, Kotaro Tanaka, Katsunori Yoshihara, Kikuo Yoh, Junichi Suzuki, Hiroshi Toyoda, Kunihiro Mashiko, Naoki Shimizu, Takashi Muguruma, Tadanaga Shimada, Yoshiro Kobe, Tomohisa Shoko, Kazuya Nakanishi, Takashi Shiga, Takefumi Yamamoto, Kazuhiko Sekine, Shinichi Izuka

Affiliations

¹ Department of Emergency and Critical Care Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
² Division of Emergency and Critical Care Medicine, Department of Acute Medicine, Nihon University School of Medicine, Tokyo, Japan.
³ Department of Emergency and Critical Care Medicine, Kimitsu Chuo Hospital, Chiba, Japan.
⁴ Department of Emergency and Critical Care Medicine, Nippon Medical School Tama Nagayama Hospital, Tokyo, Japan.
⁵ Department of Critical Care and Emergency Medicine, Tokyo Women's Medical University, Tokyo, Japan.
⁶ Department of Emergency Medicine, Teikyo University School of Medicine, Tokyo, Japan.

PMID: 32466859
DOI: 10.1016/j.jemermed.2020.04.039

Abstract

Background: The influence of institutional volume of out-of-hospital cardiac arrest (OHCA) cases on outcomes remains unclear.

Objectives: This study evaluated the relationship between institutional volume of adult, nontraumatic OHCA cases and 1-month favorable neurologic outcomes.

Methods: This study retrospectively analyzed data between January 2012 and March 2013 from a prospective observational study in the Kanto area of Japan. We analyzed adult patients with nontraumatic OHCA who underwent cardiopulmonary resuscitation by emergency medical service personnel and in whom spontaneous circulation was restored. Based on the institutional volume of OHCA cases, we divided institutions into low-, middle-, or high-volume groups. The primary and secondary outcomes were 1-month favorable neurologic outcomes and 1-month survival, respectively. A multivariate logistic regression analysis adjusted for propensity score and in-hospital variables was performed.

Results: Of 2699 eligible patients, 889, 898, and 912 patients were transported to low-volume (40 institutions), middle-volume (14 institutions), and high-volume (9 institutions) centers, respectively. Using low-volume centers as the reference, transport to a middle- or high-volume center was not significantly associated with a favorable 1-month neurologic outcome (adjusted odds ratio [OR] 1.21 [95% confidence interval {CI} 0.84-1.75] and adjusted OR 0.77 [95% CI 0.53-1.12], respectively) or 1-month survival (adjusted OR 1.10 [95% CI 0.82-1.47] and adjusted OR 0.76 [95% CI 0.56-1.02], respectively).

Conclusions: Institutional volume was not significantly associated with favorable 1-month neurologic outcomes or 1-month survival in OHCA. Further investigation is needed to determine the association between hospital characteristics and outcomes in patients with OHCA.

Keywords: cardiopulmonary resuscitation; emergency medical services; patient outcome assessment; postresuscitation care.

Publication types

Observational Study

MeSH terms

Adult
Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
Japan / epidemiology
Out-of-Hospital Cardiac Arrest* / therapy
Registries
Retrospective Studies