Abstract 17910: Are Characteristics of Hospitals Associated With Outcome in Resuscitated Patients? Insights From the Paris Sudden Death Expertise Center
Background: Since the quality of post-cardiac arrest (PCA) care may influence the outcome, the triage strategy deserves evaluation that integrates characteristics of receiving hospitals.
Hypothesis: We aimed at assessing the influence of care level center on survival rate at hospital discharge in a regional registry of out-of-hospital cardiac arrest (OHCA) patients.
Methods: In the studied system, transportation of resuscitated patients is performed after return of spontaneous circulation (ROSC) and the recommended strategy for triage aims to match hospitals’ resources and patients’ characteristics. We included all cases of adult non-traumatic OHCA admitted alive to hospital. Utstein variables and in-hospital data were prospectively collected in the registry of a large urban metropolitan area. Receiving hospitals were categorized in 3 groups (A, B and C) depending on their respective characteristics (numbers of OCHA patients per year, 24/7 cardiac catheterization availability and use of TTM), with group A corresponding to “cardiac arrest centers” and group C to “general hospitals”. We compared patients’ characteristics and we performed a multivariable logistic regression using survival at discharge as the endpoint.
Results: During the study period (May 2011 - Dec 2013), 1476 patients were admitted in 48 hospitals after ROSC. Overall survival rate at discharge was 435/1436 (30%). Patients’ baseline characteristics significantly differed, as hospitals from group A treated younger patients, with shorter duration between collapse and ROSC and more frequent shockable rhythms (p for trend <0.001). Unadjusted survival rate at discharge differed significantly among the 3 groups of hospitals (34% for A vs. 25% for B vs. 15.4% for C, p<0.01). In multivariable analysis, the category of hospital was no longer associated with survival at discharge with adjusted ORs 0.94 (CI 0.6-1.3; p=0.75) and 0.87 (CI 0.4-1.7; p=0.71) for groups B and C respectively (reference group A).
Conclusion: In this population-based study, characteristics of receiving centers are not associated with survival rate at discharge. This could result from the strategy used for triage, which aims in matching patients’ characteristics and hospitals’ resources.
Author Disclosures: R. Chocron: None. W. Bougouin: None. F. Beganton: None. E. Marijon: None. X. Jouven: None. A. Cariou: None. F. Dumas: None.
- © 2016 by American Heart Association, Inc.