Elsevier

Resuscitation

Volume 81, Issue 5, May 2010, Pages 524-529
Resuscitation

Clinical paper
Receiving hospital characteristics associated with survival after out-of-hospital cardiac arrest,☆☆

https://doi.org/10.1016/j.resuscitation.2009.12.006Get rights and content

Abstract

Aim

Survival after out-of-hospital cardiac arrest (OOHCA) varies between regions, but the contribution of different factors to this variability is unknown. This study examined whether survival to hospital discharge was related to receiving hospital characteristics, including bed number, capability of performing cardiac catheterization and hospital volume of OOHCA cases.

Material and methods

Prospective observational database of non-traumatic OOHCA assessed by emergency medical services was created in 8 US and 2 Canadian sites from December 1, 2005 to July 1, 2007. Subjects received hospital care after OOHCA, defined as either (1) arriving at hospital with pulses, or (2) arriving at hospital without pulses, but discharged or died ≥1 day later.

Results

A total of 4087 OOHCA subjects were treated at 254 hospitals, and 32% survived to hospital discharge. A majority of subjects (68%) were treated at 116 (46%) hospitals capable of cardiac catheterization. Unadjusted survival to discharge was greater in hospitals performing cardiac catheterization (34% vs. 27%, p = 0.001), and in hospitals that received ≥40 patients/year compared to those that received <40 (37% vs. 30%, p = 0.01). Survival was not associated with hospital bed number, teaching status or trauma center designation. Length of stay (LOS) for surviving subjects was shorter at hospitals performing cardiac catheterization (p < 0.01). After adjusting for all variables, there were no independent associations between survival or LOS and hospital characteristics.

Conclusions

Some subsets of hospitals displayed higher survival and shorter LOS for OOHCA subjects but there was no independent association between hospital characteristics and outcome.

Section snippets

Methods

Data were obtained from the ROC Cardiac Arrest Epidemiological Registry or “Epistry” which has been described in detail previously.12 This registry is a prospective database of all persons evaluated for OOHCA by participating EMS agencies. Over 250 EMS agencies at sites in Canada and the US contribute data on an ongoing basis. Multiple mechanisms for surveillance are used at local sites to assure investigators of capture of all appropriate cases. Data are abstracted from EMS records and

Results

Complete data were available from 8 sites in the US and 2 in Canada. EMS agencies delivered subjects to a total of 254 hospitals (144 in US and 110 in Canada). The distribution of hospital sizes was similar in the US and Canada (Table 1). A larger proportion of US hospitals performed cardiac catheterization and maintained residency programs than Canadian hospitals (Table 1). About 55% of hospitals reported being able to perform cardiac catheterization. Similar proportions of hospitals were

Discussion

After resuscitation by EMS or in the ED after OOHCA, the unadjusted probability of survival to discharge is associated with care at a hospital capable of cardiac catheterization or treating ≥40 OOHCA patients annually. Mean length of stay is also shorter for patients hospitalized at hospitals capable of cardiac catheterization. The characteristics of patients delivered to different categories of hospitals do not differ, but after adjusting for response and patient characteristics, there was no

Conflict of interest

The authors do not have any direct conflicts of interest related to the topics in this paper.

Acknowledgements

Funding sources: The ROC is supported by a series of cooperative agreements to 10 regional clinical centers and one Data Coordinating Center (5U01 HL077863, HL077881, HL077871 HL077872, HL077866, HL077908, HL077867, HL077885, HL077887, HL077873, HL077865) from the National Heart, Lung and Blood Institute in partnership with the National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)—Institute of

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    A Spanish translated version of the abstract of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2009.12.006.

    ☆☆

    A preliminary version of these data was presented at the Resuscitation Science Symposium, New Orleans, LA, November 5, 2008, and appear in abstract form in the proceedings.37.

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