Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry.

Teresa L May, Christine W Lary, Richard R Riker, Hans Friberg, Nainesh Patel, Eldar Søreide, John A McPherson, Johan Undén, Robert Hand, Kjetil Sunde, Pascal Stammet, Stein Rubertsson, Jan Belohlvaek, Allison Dupont, Karen G Hirsch, Felix Valsson, Karl Kern, Farid Sadaka, Johan Israelsson, Josef DankiewiczNiklas Nielsen, David B Seder, Sachin Agarwal

Research output: Contribution to journalArticlepeer-review

Abstract

Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
Original languageEnglish
JournalIntensive Care Medicine
DOIs
Publication statusPublished - 1 May 2019

Other keywords

  • Cardiac arrest
  • Center variability
  • Out of hospital arrest
  • Hjartastopp
  • Sjúkrahús
  • Heart Arrest
  • Treatment Outcome
  • Hospitals

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