Andreas Schober1, Fritz Sterz2, Anton N Laggner1, Michael Poppe1, Patrick Sulzgruber1, Elisabeth Lobmeyr1, Philip Datler3, Markus Keferböck1, Sebastian Zeiner1, Alexander Nuernberger1, Bettina Eder4, Georg Hinterholzer5, Daniel Mydza5, Barbara Enzelsberger6, Klaus Herbich7, Reinhard Schuster8, Elke Koeller9, Thomas Publig10, Peter Smetana11, Chrisitian Scheibenpflug12, Günter Christ13, Brigitte Meyer14, Thomas Uray1. 1. Department of Emergency Medicine, Medical University of Vienna, Austria. 2. Department of Emergency Medicine, Medical University of Vienna, Austria. Electronic address: fritz.sterz@meduniwien.ac.at. 3. Department of Anaesthesiology, General Intensive Care and Pain Management, Medical University of Vienna, Austria. 4. Municipal Ambulance Service of Vienna, Austria. 5. 1st Medical Department, Kaiser Franz Josef Spital - SMZ Süd, Vienna, Austria. 6. 2nd Medical Department, KA Rudolfstiftung, Vienna, Austria. 7. 2nd Medical Department, Emergency Unit, SMZO - Donauspital, Vienna, Austria. 8. 1st Medical Department, SMZO - Donauspital, Vienna, Austria. 9. 3rd Medical Department, KH Hietzing, Vienna, Austria. 10. 4th Medical Department, KH Hietzing, Vienna, Austria. 11. 3rd Medical Department, Wilhelminenspital, Vienna, Austria. 12. Pediatric Intensive Care, Department of Pediatric and Adolescent Surgery, SMZO - Donauspital, Vienna, Austria. 13. 5th Medical Department, Kaiser Franz Josef Spital - SMZ Süd, Vienna, Austria. 14. 4th Medical Department, Kaiser Franz Josef Spital - SMZ Süd, Vienna, Austria.
Abstract
AIM: Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to high-, medium- or low volume centers. METHODS: Analysis from a prospective, multicenter registry for out of hospital cardiac arrest patients treated by the emergency medical service of Vienna, Austria. The frequency of cardiac arrest patients admitted per center/year (low <50; medium 50-100; high >100) was correlated to favorable outcome (30-day survival with cerebral performance category of 1 or 2). RESULTS: Out of 2238 patients (years 2013-2015) with emergency medical service resuscitation, 861 (32% female, age 64 (51;73) years) were admitted to 7 different centers. Favorable outcome was achieved in 267 patients (31%). Survivors were younger (58 vs. 66 years; p<0.001), showed shockable initial heart rhythm more frequently (72 vs. 35%; p<0.001), had shorter CPR durations (22 vs. 29min; p<0.001) and were more likely to be treated in a high frequency center (OR 1.6; CI: 1.2-2.1; p=0.001). In multivariate analysis, age below 65 years (OR 15; CI: 3.3-271.4; p=0.001), shockable initial heart rhythm (OR 10.1; CI: 2.4-42.6; p=0.002), immediate bystander or emergency medical service CPR (OR 11.2; CI: 1.4-93.3; p=0.025) and admission to a center with a frequency of >100 OHCA patients/year (OR 5.2; CI: 1.2-21.7; p=0.025) was associated with favorable outcome. CONCLUSIONS: High frequency of post-cardiac arrest treatment in a specialized center seems to be an independent predictor for favorable outcome in an unselected population of patients after out of hospital cardiac arrest.
AIM: Cardiac arrest centers have been associated with improved outcome for patients after cardiac arrest. Aim of this study was to investigate the effect on outcome depending on admission to high-, medium- or low volume centers. METHODS: Analysis from a prospective, multicenter registry for out of hospital cardiac arrestpatients treated by the emergency medical service of Vienna, Austria. The frequency of cardiac arrestpatients admitted per center/year (low <50; medium 50-100; high >100) was correlated to favorable outcome (30-day survival with cerebral performance category of 1 or 2). RESULTS: Out of 2238 patients (years 2013-2015) with emergency medical service resuscitation, 861 (32% female, age 64 (51;73) years) were admitted to 7 different centers. Favorable outcome was achieved in 267 patients (31%). Survivors were younger (58 vs. 66 years; p<0.001), showed shockable initial heart rhythm more frequently (72 vs. 35%; p<0.001), had shorter CPR durations (22 vs. 29min; p<0.001) and were more likely to be treated in a high frequency center (OR 1.6; CI: 1.2-2.1; p=0.001). In multivariate analysis, age below 65 years (OR 15; CI: 3.3-271.4; p=0.001), shockable initial heart rhythm (OR 10.1; CI: 2.4-42.6; p=0.002), immediate bystander or emergency medical service CPR (OR 11.2; CI: 1.4-93.3; p=0.025) and admission to a center with a frequency of >100 OHCA patients/year (OR 5.2; CI: 1.2-21.7; p=0.025) was associated with favorable outcome. CONCLUSIONS: High frequency of post-cardiac arrest treatment in a specialized center seems to be an independent predictor for favorable outcome in an unselected population of patients after out of hospital cardiac arrest.
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