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

摘要

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.