Abstract 8: Influence of Receiving Hospital Characteristics on Survival after Cardiac Arrest

Abstract

Hospital management of out-of-hospital cardiac arrest (OHCA) patients after return of spontaneous circulation (ROSC) can influence patient survival via interventions such as hypothermia and cardiac catheterization (CATH). This study tested the hypothesis that survival differed between different types of hospitals for subjects with ROSC after OHCA. Methods: Adult (≥ 18 years) subjects with paramedic-documented ROSC or who lived >1 day after OHCA were identified with their receiving hospital in a prospective database from 9 regions in the US and Canada. Hospitals were characterized using the American Hospital Directory or the Guide to Canadian Healthcare Facilities. Hospitals were categorized by bed number (large >400; medium 250 – 400; small <250) and CATH capability. Associations between clinical variables, hospital categories, survival time, and survival to hospital discharge were determined using Cox regression and analysis of variance. Results: Between December 2005 and July 2007, 3644 OHCA subjects were treated in 254 hospitals, with similar numbers in large (1026), medium (1094) and small (1276) hospitals. CATH hospitals treated 2123 (58%) subjects, and patient features (63% male, 42% VF/VT, 67% witnessed collapse, and mean call-arrival interval of 5.7 (SD 2.8) minutes) did not differ between hospital categories. CATH hospitals had higher survival than non-CATH hospitals in large (35.1% vs. 27.7%), medium (34.4% vs. 30.7%) and small (38.6% vs. 26.5%) categories (F=19.55; p<0.001). VF/VT (p < 0.001), age (p < 0.001) and witnessed collapse (p < 0.001) were associated with survival time. When adjusted for initial rhythm, call-arrival interval, witnessed collapse, age, sex, region, teaching institution, and trauma center level, there was no significant effect of CATH. However, the interaction of large hospital and CATH was associated with lower hazard of death (0.71, 95% CI [0.54, 0.93]). Conclusions: Transport to a CATH hospital is associated with increased probability of survival to discharge after OHCA. These data cannot determine whether cardiac catheterization was performed or if CATH hospital is a surrogate for more comprehensive cardiac care. Therefore, further work should examine what aspects of in-hospital care affected outcome.

Part 8: Education, implementation, and teams

“…154 There were 10 observational studies that compared OHCA patient survival outcomes between hospitals based on various hospital characteristics such as hospital type, hospital size, hospital location, and OHCA case volume. [155][156][157][158][159][160][161][162][163][164] Six observational studies compared OHCA patient survival outcomes before and after the implementation of a regionalized system of postresuscitation care. [165][166][167][168][169][170] Six observational studies compared patient…”

“…154 For the important outcome of survival, we identified very-low-quality evidence (downgraded for significant risk of bias and indirectness, with heterogeneity in reported hospital factors associated with differences in patient survival) from 21 studies with more than 120 000 patients. Three studies examined survival at 30 days, 159,161,173 18 studies with more than 120 000 patients reported survival to hospital discharge, [155][156][157][158][159][160]163,164,166,[168][169][170][171][172][174][175][176] and 1 study reported survival at 4.6 years. 162 There was an association with survival and transport to a cardiac arrest center; however, the specific hospital factors most related to patient outcome were inconsistent in these studies.…”