Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry

Abstract

Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient-and arrest-specific characteristics and evaluated how in-hospital management differs between high-and low-performing centers. Methods: Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, preexisting functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. Results: A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Conclusions: Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.

The cardiac arrest centre for the treatment of sudden cardiac arrest due to presumed cardiac cause – aims, function and structure: Position paper of the Association for Acute CardioVascular Care of the European Society of Cardiology (AVCV), European Association of Percutaneous Coronary Interventions (EAPCI), European Heart Rhythm Association (EHRA), European Resuscitation Council (ERC), European Society for Emergency Medicine (EUSEM) and European Society of Intensive Care Medicine (ESICM)

“…7,13 Although effective therapies are available for OHCA patients, these are often used insufficiently because of lack of resources, staff, infrastructure, experience and knowledge in the responsible medical systems. 14…”

Clinical Characteristics and In-Hospital Mortality of Cardiac Arrest Survivors in Brazil: A Large Retrospective Multicenter Cohort Study

“…A recent analysis of OHCA patients from the International CA Registry treated with TTM showed profound differences in the rates of good functional outcomes, which persisted after adjustment for patient-specific factors, with risk-adjusted good outcomes ranging from 20% to 50% ( 22 ). High-performing centers reported greater use of temperature targets 33°C, faster TTM implementation, and higher rates of early cardiac revascularization.…”

Veno-arterial CO2 difference and respiratory quotient after cardiac arrest: An observational cohort study

“…Furthermore, some patients may need longer than 72 h to regain consciousness, and there is a risk of poor outcome if intensive care is terminated too early (126,333,347). A previous study identified differences between hospitals in the duration of intensive care provided to post-cardiac arrest patients (335), and other studies report that outcomes after cardiac arrest vary geographically and between hospitals (348)(349)(350)(351)(352)(353). Studies assessing whether differences in duration of intensive care efforts affects patient outcome are scarce (334).…”