Abstract 166: Hospital Experience with Post Out-of-Hospital Cardiac Arrest Patients Is Associated with Successful Targeted Temperature Management
Background: Hospitals vary in the number of out-of-hospital cardiac arrest (OHCA) patients they treat on an annual basis. Institutional experience with this type of complex patient may be associated with the quality of post-cardiac arrest care delivered by a hospital, specifically targeted temperature management (TTM).
Objective: To evaluate the association between average annual hospital volume of post-OHCA patients eligible for TTM and the delivery of successful TTM.
Methods: This retrospective, population-based cohort study used consecutive non-traumatic OHCA cases presenting to the 37 hospitals in the Strategies for Post Arrest Care (SPARC) network of Southern Ontario from 09/01/07 to 12/31/13. We included adult patients who achieved return of spontaneous circulation, survived at least 6 hours post-arrest and were comatose. We excluded patients with a pre-existing Do-Not-Resuscitate order. A multi-level logistic regression model was constructed with hospital as the cluster. Successful TTM was defined as having a core body temperature of 32-34 degrees Celsius within 6 hours of hospital arrival.
Results: From 40,573 OHCAs in the SPARC region over the study period, the final cohort included 2,723 eligible patients. Overall, 33% (895/2723) had successful TTM. Successful TTM varied significantly between 3 hospital volume groups (26% (184/721) for <15 patients per year, 33% (342/1024) for 15-25 patients per year, and 38% (369/978) for >25 patients per year; p<0.01). The volume groups were comparable on patient factors. The intracluster correlation coefficient demonstrated 11% of the variability in successful TTM was attributable to hospital-level factors. Multilevel analysis revealed for each 10 unit increase in annual volume of patients eligible for TTM, the adjusted odds for successful TTM was almost 30% higher (OR 1.29, CI95 1.03-1.62).
Conclusions: Successful TTM varied markedly between hospitals on the basis of experience with post-OHCA patients. Patients who received successful TTM were more likely to have arrived at hospitals with more experience in post-OHCA patients. Further study is needed to identify other hospital-level factors contributing to the observed variability in successful TTM.
Author Disclosures: H.C. Worthington: None. C. Zhan: None. K. Dainty: None. P. Dorian: None. N. Ferguson: None. S. Lin: None. L.J. Morrison: Research Grant; Significant; Heart and Stroke Foundation of Canada, CIHR, NIH, Laerdal Foundation. W. Pickett: None. D. Scales: None. S.C. Brooks: Research Grant; Significant; Heart and Stroke Foundation of Canada.
- © 2014 by American Heart Association, Inc.