Steve Balian1, David G Buckler1, Audrey L Blewer2, Abhishek Bhardwaj1, Benjamin S Abella3. 1. Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. 2. Department of Community and Family Medicine, Duke University School of Medicine, NV, USA. 3. Center for Resuscitation Science and Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: benjamin.abella@uphs.upenn.edu.
Abstract
AIM OF THE STUDY: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. METHODS: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission. We compared post-arrest treatments across hospitals stratified into arrest volume quartiles. Logistic regression models were used to assess the volume-outcome relationship. RESULTS: We analyzed 3512 OHCAs admitted to 48 hospitals. Survival to discharge (24-65%) and neurological recovery (15-56%) were highly varied between hospitals. Compared to lower performing hospitals, hospitals with higher survival rates (≥ 40%) performed significantly more coronary angiographies (32% vs. 26%), stenting (17.5% vs. 13%), and ICD placements (12.5% vs 7.4%). Across volume quartiles, no significant differences were found in percent of treatment provision or outcomes. After adjustment for patient demographics, prehospital and post-arrest care variables, odds of survival and neurological recovery were 43% (OR 1.43; 95% CI, 1.08-1.89) and 51% (OR 1.51; 95% CI, 1.11-2.04) higher in hospitals with greater receiving volumes, respectively. CONCLUSIONS: Hospital case volume is associated with improved patient outcomes. Inter-hospital variability in OHCA outcomes may potentially be addressed by regionalization of care to high volume centers with higher rates of post-arrest care provision and better patient outcomes.
AIM OF THE STUDY: Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. METHODS: This retrospective study (2013-2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission. We compared post-arrest treatments across hospitals stratified into arrest volume quartiles. Logistic regression models were used to assess the volume-outcome relationship. RESULTS: We analyzed 3512 OHCAs admitted to 48 hospitals. Survival to discharge (24-65%) and neurological recovery (15-56%) were highly varied between hospitals. Compared to lower performing hospitals, hospitals with higher survival rates (≥ 40%) performed significantly more coronary angiographies (32% vs. 26%), stenting (17.5% vs. 13%), and ICD placements (12.5% vs 7.4%). Across volume quartiles, no significant differences were found in percent of treatment provision or outcomes. After adjustment for patient demographics, prehospital and post-arrest care variables, odds of survival and neurological recovery were 43% (OR 1.43; 95% CI, 1.08-1.89) and 51% (OR 1.51; 95% CI, 1.11-2.04) higher in hospitals with greater receiving volumes, respectively. CONCLUSIONS: Hospital case volume is associated with improved patient outcomes. Inter-hospital variability in OHCA outcomes may potentially be addressed by regionalization of care to high volume centers with higher rates of post-arrest care provision and better patient outcomes.
Authors: Amelia Xin Chun Goh; Jie Cong Seow; Melvin Yong Hao Lai; Nan Liu; Yi Man Goh; Marcus Eng Hock Ong; Shir Lynn Lim; Jamie Sin Ying Ho; Jun Wei Yeo; Andrew Fu Wah Ho Journal: JAMA Netw Open Date: 2022-05-02
Authors: Jun Wei Yeo; Zi Hui Celeste Ng; Amelia Xin Chun Goh; Jocelyn Fangjiao Gao; Nan Liu; Shao Wei Sean Lam; Yew Woon Chia; Gavin D Perkins; Marcus Eng Hock Ong; Andrew Fu Wah Ho Journal: J Am Heart Assoc Date: 2021-12-20 Impact factor: 6.106
Authors: Ryan Huebinger; Jordan Thomas; Benjamin S Abella; John Waller-Delarosa; Rabab Al-Araji; Richard Witkov; Normandy Villa; Peter Nikonowicz; Taylor Renbarger; Micah Panczyk; Bentley Bobrow Journal: Resusc Plus Date: 2022-04-05