Abstract 104: Hospital Characteristics Associated with Survival After Out-of-Hospital Cardiac Arrest: Resuscitation Center Designation
Background: Survival after out-of-hospital cardiac arrest (OHCA) varies between emergency medical service (EMS) systems, but the contribution of different receiving hospital (RH) characteristics to this variability is unknown.
Objectve: To examine whether survival after OHCA is related to RH characteristics.
Material and Methods: We did a prospective 4-year observational study of adult non-traumatic OHCA in an urban EMS. RH characteristics were Critical Care Level (CCL- high, middle, general), teaching status, public or private, and yearly OHCA volume. CCL was nationally categorized by their expertise of providing emergency cardiac catheterization, 24-hour emergency physicians and intensivists, post-arrest protocol, and timely thrombolysis for stroke. Other potential prognostic factors for regression analysis included age, sex, arrest witnessed, bystander CPR, initial cardiac rhythms, EMS time intervals, advanced level paramedics (ALS), and with malignancy. The primary endpoint was survival to hospital discharge; the secondary was favorable Cerebral Performance Category (CPC: 1-2).
Results: A total of 3,890 OHCA subjects were treated at 20 RHs. Survival to discharge was greater in RHs of high CCL (5.9% vs 4.5%, OR: 1.6, 95% CI 1.1-2.3), university teaching hospital (5.5% vs 3.4%, OR: 2.1, 95% CI 1.4-3.1), private (6.2% vs 3.9%, OR: 1.5, 95% CI 1.1-2.1), and lower OHCA volume (OR: 1.0, 95% CI 1.0-1.01). Adjusted survival to discharge for all variables remained independently greater in university teaching hospital (OR: 1.7, 95% CI 1.1-2.7) and lower volume of cases (OR: 1.0, 95% CI 1.0-1.01). Other factors associated for better survival include initial shakable rhythm (OR: 4.3, 95% CI 2.9-6.3), arrest witnessed (OR: 1.9, 95% CI 1.4-2.6), with bystander CPR (OR: 1.8, 95% CI 1.2-2.7), shorter response time (OR: 1.1, 95% CI 1.0-1.2) and scene time (OR: 1.1, 95% CI 1.0-1.1), and younger age (OR: 1.0, 95% CI 1.0-1.0). Favorable CPC was not associated with studied hospital characteristics.
Conclusions: Receiving hospitals of high CCL, university teaching, private, and lower OHCA volume displayed higher survival after OHCA; university teaching status was an independent predictor. EMS system should designate specific RHs as “resuscitation center”.
- © 2011 by American Heart Association, Inc.