Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest

Abstract

Aim-Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases.Material and Methods-Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died ≥ 1 day later.Results-A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% versus 27%, p=0.001), and in hospitals that received ≥40 patients / year compared to those that received <40 (37% vs 30%, p=0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for © 2010 Elsevier Ireland Ltd. All rights reserved.Correspondence: Clifton W. Callaway, MD, PhD, University of Pittsburgh, Department of Emergency Medicine, 3600 Forbes Ave #400A, Pittsburgh, PA 15261, 412-647-9047, FAX 412-647-6999, callawaycw@upmc.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conflict of Interest StatementThe authors do not have any direct conflicts of interest related to the topics in this paper.A preliminary version of these data was presented at the Resuscitation Science Symposium, New Orleans, LA, November 5, 2008, and appear in abstract form in the proceedings, as: Callaway CW, Schmicker R, Kampmeyer M, Powel J, Nichol G, Rea TD, Daya M, Aufderheide T, Davis D, Rittenberger J, Idris AH. Influence of receiving hospital characteristics on survival after cardiac arrest. Circulation 2008;118 (Supp 2):S1446. NIH Public Access Author ManuscriptResuscitation. Author manuscript; available in PMC 2011 May 1. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript surviving subjects was shorter at hospitals performing cardiac catheterization (p<0.01).After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics.Conclusions-Some subsets of hospitals displayed higher surviv...

The Role of EMS in Regionalized Systems of Care

“…Although there is nothing magical about the one-hour mark in trauma, it does represent an important concept; rapid, specialized treatment results in improved clinical outcomes. 1 This time-sensitive concept is applied to a number of high-intensity, critical conditions, including ST-elevation myocardial infarction (STEMI) 2 , cerebrovascular accident (CVA) 3 , out-ofhospital cardiac arrest (OHCA) 4 , and sepsis. 5,6 Since the era of bed rest for the treatment of STEMI in the 1960s 7 , the treatment of this and many other lifethreatening conditions has undergone profound changes, leading to the development of "regionalized systems of care" using hospital-based "centres of excellence," which provide advanced diagnostics, interventions, and expertise not routinely available in typical referral hospitals.…”

“…[15][16][17] The importance of developing regionalized systems is further supported by a number of national organizations in Canada and the United States. [18][19][20][21] Historically, the drivers of regionalized systems of care have been trauma and STEMI; however, other systems include stroke, traumatic brain injury (TBI) 22 , OHCA 4,23 , and burns…”

“…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.…”

Advances in Resuscitation

“…2,111,112 This may reflect health, racial, or socioeconomic disparities; layperson involvement; or local EMS skill and capacity. However, variability in the hospital volume of post-cardiac arrest patients, specialized capabilities such as PCI or TH, and the quality of post-cardiac arrest care are also likely contributors.…”

From Door to Recovery: A Collaborative Approach to the Development of a Post–Cardiac Arrest Center

“…7,8,15 Cudnik et al 16 reported that individual hospital rates of survival varied widely and hospital volume was not associated with likelihood of survival. Hospital characteristics other than volume might account for the variability observed in OHCA hospital outcomes.…”