Increasing Hospital Volume is Not Associated with Improved Survival in Out of Hospital Cardiac Arrest of Cardiac Etiology

• Type of Material: Article
• Authors: Michael T. Cudnik, Ohio State University; Comilla Sasson, University of Colorado; Thomas D. Rea, University of Washington; Michael R. Sayre, Ohio State University; Jianying Zhang, Ohio State University; Bentley J. Bobrow, University of Arizona; Daniel W. Spaite, University of Arizona; Bryan McNally, Emory University; Kurt Denninghoff, University of Arizona; Uwe Stolz, University of Arizona
• Language: English
• Date: 2012-07-01
• Publisher: Elsevier: 12 months
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Published by Elsevier Ireland Ltd.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.resuscitation.2012.02.006
• Title of Journal or Parent Work: Resuscitation
• ISSN: 0300-9572
• Volume: 83
• Issue: 7
• Start Page: 862
• End Page: 868
• Grant/Funding Information: Neither funding source had any role in the study design, collection, analysis, interpretation of the data, nor the writing or submission of the manuscript.; The Cardiac Arrest Registry to Enhance Survival (CARES) is funded by grant support from the Centers for Disease Control and Prevention (CDC) and Emory University; The primary author MTC has funding support from the National Research Program of the American Heart Association (Award # 0835250N).
• Keywords: Health outcomes; CARE; TRAUMA CENTERS; UNITED-STATES; Resuscitation; ACUTE MYOCARDIAL-INFARCTION; General & Internal Medicine; Life Sciences & Biomedicine; LEVEL-I; Emergency Medicine; Science & Technology; MORTALITY-RATES; ARTERY-BYPASS SURGERY; Out of hospital cardiac arrest; AMERICAN-HEART-ASSOCIATION; Critical Care Medicine; STROKE; 10-YEAR FOLLOW-UP
• Research Categories: Health Sciences, General; Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI950.83-1.28) among 11-39 annual volume and 0.97 (CI950.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.