A national analysis of the relationship between hospital factors and post-cardiac arrest mortality

Abstract

Mortality after in-hospital cardiac arrest decreased over 5 years. Mortality was lower at urban, teaching, and large hospitals. There are implications for dissemination of best practices or regionalization of post-cardiac arrest care.

Part 12: Education, Implementation, and Teams

“…Seven observational studies showed wide variability in survival to hospital discharge, [407][408][409][410][411] 1-month survival, 412 or length of intensive care unit (ICU) stay 413 among hospitals caring for patients after resuscitation from cardiac arrest. One North American observational study 411 showed that highervolume centers (Ͼ50 ICU admissions following cardiac arrest per year) had a better survival to hospital discharge than low-volume centers (Ͻ20 cases admitted to ICU following cardiac arrest) for patients treated for either in-or out-ofhospital cardiac arrest.…”

“…Two small LOE 3 observational studies 417,418 demonstrated a trend toward improvement that was not statistically significant when comparing historic controls with the introduction of a comprehensive package of post resuscitation care, which included therapeutic hypothermia, PCI, and goal-directed therapy. One LOE 4 observational study 409 suggested improved survival to discharge after out of hospital cardiac arrest in large hospitals with cardiac catheter facilities compared with smaller hospitals with no cardiac catheter facilities. Another LOE 4 observational study 414 also showed improved outcome in hospitals with cardiac catheter facilities that was not statistically significant after adjustment for other variables.…”

Post-Cardiac Arrest Therapeutic Hypothermia in New Jersey Hospitals: Analysis of Adoption and Implementation

“…The low volumes of OHCA patients seen by many New Jersey hospitals highlights the need to better understand whether there is a volume-outcome relationship for TH similar to that which has been demonstrated for other medical interventions, particularly those involving cardiac procedures (Canto et al, 2000;Nathens et al, 2001;Birkmeyer et al, 2003;Carr et al, 2009a). One recent study in particular finds that survival from OHCA is greatly reduced in hospitals that treat fewer than 40 cases per year .…”

The Role of EMS in Regionalized Systems of Care

“…There is strong evidence that the number of cases treated at a particular institution, or by a particular practitioner, is directly correlated with patient outcome, providing further evidence in support of centres of excellence. 4,[44][45][46][47] There are a number of reasons why patients requiring specialized care may not be bypassed to a centre of excellence, including: a) a substantial proportion of patients do not live within the catchment area and are not eligible for prehospital bypass programs; 48,49 b) a significant number of patients do not call 911 and instead seek medical attention on their own; and c) a paramedic may not identify a patient who qualifies for prehospital bypass, or the condition of interest may not develop until after the patient has arrived at the general ED.…”