Tasuku Matsuyama1, Kosuke Kiyohara2, Tetsuhisa Kitamura3, Chika Nishiyama4, Tatsuya Nishiuchi5, Yasuyuki Hayashi6, Takashi Kawamura7, Bon Ohta1, Taku Iwami7. 1. Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan. 2. Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan. 3. Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-5 Yamada-oka, Suita, Osaka 565-0871, Japan. Electronic address: lucky_unatan@yahoo.co.jp. 4. Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan. 5. Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan. 6. Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan. 7. Kyoto University Health Services, Kyoto, Japan.
Abstract
OBJECTIVE: To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012. We divided acute care hospitals into CCMCs or non-CCMCs, the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases: low-volume (≤10 cases), middle-volume (11-39 cases), and high-volume (≥40 cases) groups. Random effects logistic regression models, with hospital treated as a random effect, were used to assess factors potentially associated with a favourable neurological outcome. RESULTS: A total of 44,474 patients were eligible. The proportions of favourable neurological outcome from OHCA were 0.9% (31/3559) in the low-volume group, 1.2% (106/9171) in the middle-volume group, 1.6% (222/14,007) in the high-volume group, and 4.3% (766/17,737) in the CCMC group (P<0.001). In the multivariable analysis, transport to CCMCs was significantly associated with favourable neurological outcome, compared with transport to non-CCMCs (adjusted odds ratio 1.63; 95% confidence interval, 1.60-1.66). Among the non-CCMC group, there was no significant relationship between hospital volume and favourable neurological outcome. CONCLUSIONS: In this population, transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA, whereas no significant association was noted among the hospitals with different volumes.
OBJECTIVE: To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA). METHODS: This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012. We divided acute care hospitals into CCMCs or non-CCMCs, the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases: low-volume (≤10 cases), middle-volume (11-39 cases), and high-volume (≥40 cases) groups. Random effects logistic regression models, with hospital treated as a random effect, were used to assess factors potentially associated with a favourable neurological outcome. RESULTS: A total of 44,474 patients were eligible. The proportions of favourable neurological outcome from OHCA were 0.9% (31/3559) in the low-volume group, 1.2% (106/9171) in the middle-volume group, 1.6% (222/14,007) in the high-volume group, and 4.3% (766/17,737) in the CCMC group (P<0.001). In the multivariable analysis, transport to CCMCs was significantly associated with favourable neurological outcome, compared with transport to non-CCMCs (adjusted odds ratio 1.63; 95% confidence interval, 1.60-1.66). Among the non-CCMC group, there was no significant relationship between hospital volume and favourable neurological outcome. CONCLUSIONS: In this population, transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA, whereas no significant association was noted among the hospitals with different volumes.
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