Variation in survival after out-of-hospital cardiac arrest between receiving hospitals in Japan: an observational study

Abstract

ObjectivesPatient outcomes after out-of-hospital cardiac arrest (OHCA) varies at multilevel (geographical regions, emergency medical service agencies and receiving hospitals) in the USA. However, it remains unclear whether there is a variation in patient outcomes after OHCA between relevant units of the healthcare system such as receiving hospitals in Japan. Therefore, we aimed to quantify the variation in patient outcomes after OHCA between receiving hospitals in Japan.DesignSecondary analysis of the prospective multicentre OHCA registry.SettingThe Japan Association for Acute Medicine OHCA Registry, a prospective multicentre OHCA registry, including 73 medical institutions in Japan.Participants9303 adults (≥18 years old) with OHCA of medical origin, treated at 67 hospitals from June 2014 to December 2015.Primary and secondary outcome measuresThe primary outcome was 1-month survival after OHCA. The secondary outcome was favourable functional status at 1 month, defined as cerebral performance category scale 1 or 2. We constructed a series of multivariable hierarchical logistic regression models predicting outcomes, accounting for patient-level variables and clustering of patients within hospitals. We evaluated the adjusted 1-month survival and functional outcome for each hospital, ranked hospitals for each outcome and calculated median ORs (MORs) to quantify the between-hospital variation in outcomes.ResultsThe prevalence of 1-month survival after OHCA was 7.1% (663/9303) and that of favourable functional outcome was 3.6% (331/9303). After adjustment for patient-level factors, we observed variations in 1-month survival (range, 1.6%–13.8%; adjusted MOR 1.34; 95% CI 1.16 to 1.67) and favourable functional outcome (range, 0.7%–7.3%; adjusted MOR 1.53; 95% CI 1.10 to 2.24) between hospitals.ConclusionsWe found substantial variations in patient outcomes after OHCA within a large group of hospitals in Japan, despite adjustment for patient factors that are known to be associated with different outcomes.

Initial Outcomes and Survival of Out-of-Hospital Cardiac Arrest: EuReCa Serbia Multicenter Cohort Study

“…The rate of survival to hospital discharge of 18.8% in all-cause OHCA patients observed in this study is also comparable to the majority of previously reported rates in recently published studies [ 2 , 3 ], as well as 30-day survival rate which is comparable with the values observed in other countries and reported in ERC Guidelines 2021 [ 19 , 20 ].…”

Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups

“…The prognosis of out-of-hospital cardiac arrest (OHCA) is very poor, with the survival rate ranging from 2 to 11% in the Asia-Pacific area [1]. Many prehospital factors influence the outcomes of OHCA, such as witnessing the OHCA, bystander cardiopulmonary resuscitation (CPR), initial heart rhythm, level of hospital care, location, and time of OHCA [2][3][4][5].…”

Response Time Threshold for Predicting Outcomes of Patients with Out-of-Hospital Cardiac Arrest

“…Many prehospital factors might influence the outcomes of OHCA, such as location of OHCA, witnessed arrest, bystander cardiopulmonary resuscitation (CPR), initial cardiac rhythm, and level of post-resuscitation care [ 3 – 6 ]. The emergency medical service (EMS) response time is defined as the time interval between the call made to the EMS and the arrival of the EMS team at the scene.…”