The impact of hospital experience with out-of-hospital cardiac arrest patients on post cardiac arrest care

Worthington, Heather; Pickett, Will; Morrison, Laurie J.; Scales, Damon C.; Chen, Zhan; Lin, Steve; Dorian, Paul; Dainty, Katie N.; Ferguson, Niall D.; Brooks, Steven C.

doi:10.1016/j.resuscitation.2016.08.032

Cited by 20 publications

(16 citation statements)

References 41 publications

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“…While some research finds an association between hospital volume cardiac arrest care quality, as higher volume facilities tend to provide more consistent post-arrest care and have better patient outcomes, 22. , 33. , 34.…”

Section: Discussionmentioning

confidence: 99%

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

et al. 2022

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Section: Discussionmentioning

confidence: 99%

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

et al. 2022

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“…A total of 618 duplicated articles were removed; 1679 articles were excluded based on their titles and abstracts; and a further 22 articles were excluded on full-text review. Sixteen studies 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 qualified for analysis. The study selection process and reasons for excluding the 22 studies are detailed in the flowchart in Figure 1 .…”

Section: Resultsmentioning

confidence: 99%

Association of High-Volume Centers With Survival Outcomes Among Patients With Nontraumatic Out-of-Hospital Cardiac Arrest

et al. 2022

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Key Points Question Is treatment at a high-volume center associated with improved survival and neurological outcomes among adult patients with nontraumatic out-of-hospital cardiac arrest (OHCA)? Findings In this systematic review and meta-analysis of 16 articles involving 82 769 patients with OHCA, survival to discharge or 30 days improved with treatment at a high-volume center; there was no association between center volume and good neurological outcomes at 30 days or at hospital discharge. Meaning These findings suggest that treatment at a high-volume center may improve survival but not neurological outcomes in patients with OHCA; more studies evaluating the relative importance of center volume compared with other variables associated with survival outcomes in these patients are required.

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“…72 For OHCA, however, there is inconsistency between studies as to the relationship between hospital volume and its effect on patient outcome. [93][94][95][96][97][98] For example, Schober et al 94 included 2238 OHCA patients admitted to seven hospitals in Vienna, Austria, and found that the highest volume centre reported the highest survival rate. In contrast, Cudnik et al 93 analysed data from 4125 patients with OHCA of cardiac origin admitted to 155 US hospitals, but found no association between volume and patient outcome.…”

Section: Modifiable Factorsmentioning

confidence: 99%

Variation in outcome of hospitalised patients with out-of-hospital cardiac arrest from acute coronary syndrome: a cohort study

Couper

Kimani

Gale

et al. 2018

Health Serv Deliv Res

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Background Each year, approximately 30,000 people have an out-of-hospital cardiac arrest (OHCA) that is treated by UK ambulance services. Across all cases of OHCA, survival to hospital discharge is less than 10%. Acute coronary syndrome (ACS) is a common cause of OHCA. Objectives To explore factors that influence survival in patients who initially survive an OHCA attributable to ACS. Data source Data collected by the Myocardial Ischaemia National Audit Project (MINAP) between 2003 and 2015. Participants Adult patients who had a first OHCA attributable to ACS and who were successfully resuscitated and admitted to hospital. Main outcome measures Hospital mortality, neurological outcome at hospital discharge, and time to all-cause mortality. Methods We undertook a cohort study using data from the MINAP registry. MINAP is a national audit that collects data on patients admitted to English, Welsh and Northern Irish hospitals with myocardial ischaemia. From the data set, we identified patients who had an OHCA. We used imputation to address data missingness across the data set. We analysed data using multilevel logistic regression to identify modifiable and non-modifiable factors that affect outcome. Results Between 2003 and 2015, 1,127,140 patient cases were included in the MINAP data set. Of these, 17,604 OHCA cases met the study inclusion criteria. Overall hospital survival was 71.3%. Across hospitals with at least 60 cases, hospital survival ranged from 34% to 89% (median 71.4%, interquartile range 60.7–76.9%). Modelling, which adjusted for patient and treatment characteristics, could account for only 36.1% of this variability. For the primary outcome, the key modifiable factors associated with reduced mortality were reperfusion treatment [primary percutaneous coronary intervention (pPCI) or thrombolysis] and admission under a cardiologist. Admission to a high-volume cardiac arrest hospital did not influence survival. Sensitivity analyses showed that reperfusion was associated with reduced mortality among patients with a ST elevation myocardial infarction (STEMI), but there was no evidence of a reduction in mortality in patients who did not present with a STEMI. Limitations This was an observational study, such that unmeasured confounders may have influenced study findings. Differences in case identification processes at hospitals may contribute to an ascertainment bias. Conclusions In OHCA patients who have had a cardiac arrest attributable to ACS, there is evidence of variability in survival between hospitals, which cannot be fully explained by variables captured in the MINAP data set. Our findings provide some support for the current practice of transferring resuscitated patients with a STEMI to a hospital that can deliver pPCI. In contrast, it may be reasonable to transfer patients without a STEMI to the nearest appropriate hospital. Future work There is a need for clinical trials to examine the clinical effectiveness and cost-effectiveness of invasive reperfusion strategies in resuscitated OHCA patients of cardiac cause who have not had a STEMI. Funding The National Institute for Health Research Health Services and Delivery Research programme.

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The impact of hospital experience with out-of-hospital cardiac arrest patients on post cardiac arrest care

Cited by 20 publications

References 41 publications

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

Association of High-Volume Centers With Survival Outcomes Among Patients With Nontraumatic Out-of-Hospital Cardiac Arrest

Variation in outcome of hospitalised patients with out-of-hospital cardiac arrest from acute coronary syndrome: a cohort study

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