Abstract 86: Association Between Hospital Postresuscitative Performance and Clinical Outcomes in Patients with Out-of-Hospital Cardiac Arrest
Context: Whilst performance measures have been extensively evaluated in conditions such as myocardial infarction, it remains unclear if adherence to post-resuscitation guidelines is associated with better outcome in patients hospitalized after out-of-hospital cardiac arrest (OHCA).
Objectives: To assess whether survival and good functional status at discharge are associated with post-resuscitation performance score based on treatment guidelines for patients with OHCA, comprised of a) initiation of temperature management; b) target temperature 320-340C achieved; c) temperature management continued for more than 12 hours; d) coronary angiography performed within 24 hrs; e) life sustaining treatment not withdrawn prior to day 3.
Methods: An observational analysis of hospital care in 111 North American hospitals, including 3252 patients enrolled in the Resuscitation Outcomes Consortium (ROC-PRIMED) study, between 2007 and 2009, following OHCA. Performance scores were calculated, utilizing opportunity based scoring, with each factor weighted equally and scaled from 0-1. Scores for individual patients were grouped at the hospital level, with hospitals divided for descriptive purposes into quartiles based on their median opportunity composite score.
Results: Performance score varied widely (median [IQR] scores from lowest to highest hospital quartiles, 21% [20%-25%] vs 59% [55%-64%]. Adjusted survival to discharge increased with each quartile of performance score (lowest to highest: 16.2%, 20.8%, 28.5%, 34.8%, P<0.01). Similarly adjusted rates of good functional outcome improved (lowest quartile to highest: 8.3%, 13.8%, 22.2%, 25.9%, P<0.01). Hospital performance score were significantly associated with outcome after risk adjustment for established prehospital resuscitative factors (Highest versus lowest adherence quartile: adjusted OR of survival 1.64; 95% CI 1.13, 2.38)
Conclusions: Increased survival and improved functional status at discharge are associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Measuring, reporting and improving hospital adherence to guideline-based performance metrics could improve outcomes following OHCA.
- Performance measurement
- Cardiac arrest
- Therapeutic hypothermia
- Percutaneous coronary intervention (PCI)
Author Disclosures: D. Stub: None. R.H. Schmicker: None. M.L. Anderson: None. E.D. Peterson: None. C.W. Callaway: None. M.R. Daya: None. M.R. Sayre: None. J. Elmer: None. B. Grunau: None. T.P. Aufderheide: None. S. Lin: None. J. Buick: None. D. Zive: None. G. Nichol: None.
- © 2014 by American Heart Association, Inc.