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

Forskningsoutput: TidskriftsbidragArtikel i vetenskaplig tidskrift

Abstract

Purpose: 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, pre-existing 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.

Detaljer

Författare
  • Teresa L. May
  • Christine W. Lary
  • Richard R. Riker
  • Nainesh Patel
  • Eldar Søreide
  • John A. McPherson
  • Robert Hand
  • Kjetil Sunde
  • Pascal Stammet
  • Stein Rubertsson
  • Jan Belohlvaek
  • Allison Dupont
  • Karen G. Hirsch
  • Felix Valsson
  • Karl Kern
  • Farid Sadaka
  • Johan Israelsson
  • David B. Seder
  • Sachin Agarwal
Enheter & grupper
Externa organisationer
  • Skåne University Hospital
  • Stavanger University Hospital
  • University of Bergen
  • Vanderbilt University
  • Oslo university hospital
  • University of Oslo
  • Uppsala universitet
  • General University Hospital in Prague
  • Stanford University
  • National University Hospital of Iceland
  • University of Arizona
  • Saint Louis University School of Medicine
  • Kalmar County Hospital
  • Helsingborg Hospital
  • Maine Medical Center
  • Lehigh Valley Hospital
  • Luxembourg Rescue Services Agency
  • Eastern Maine Medical Center
  • New York Presbyterian Hospital
Forskningsområden

Ämnesklassifikation (UKÄ) – OBLIGATORISK

  • Anestesi och intensivvård

Nyckelord

Originalspråkengelska
Sidor (från-till)637-646
TidskriftIntensive Care Medicine
Volym45
Utgåva nummer5
Tidigt onlinedatum2019
StatusPublished - 2019
PublikationskategoriForskning
Peer review utfördJa