Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest.
Cardiac arrest
Out-of-Hospital Cardiac Arrest
PCI
Post-arrest care
TTM
Journal
Resuscitation plus
ISSN: 2666-5204
Titre abrégé: Resusc Plus
Pays: Netherlands
ID NLM: 101774410
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
30
12
2021
revised:
18
03
2022
accepted:
21
03
2022
entrez:
18
4
2022
pubmed:
19
4
2022
medline:
19
4
2022
Statut:
epublish
Résumé
Large variation exists for out-of-hospital-cardiac-arrest (OHCA) prehospital care, but less is known about variations in post-arrest care. We sought to evaluate variation in post-arrest care in Texas as well as factors associated with higher performing hospitals. We analyzed data in Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES), including all adult, non-traumatic OHCAs from 1/1/2014 through 12/31/ 2020 that survived to hospital admission. We first evaluated variability in provisions of post-arrest care and outcomes. We then stratified hospitals into quartiles based on their rate of survival and evaluated the association between improving quartiles and care. Lastly, we evaluated for outliers in post-arrest care and outcomes using a mixed-effect regression model. We analyzed 7,842 OHCAs admitted to 146 hospitals. We identified large variations in post-arrest care, including targeted temperature management (TTM) (IQR 7.0-51.1%), left heart catheterization (LHC) (IQ 0-25%), and percutaneous coronary intervention (PCI) (IQR 0-10.3%). Higher performing hospital quartiles were associated with higher rates of TTM (aOR 1.42, 95% CI 1.36-1.49), LHC (aOR 2.07, 95% CI 1.92-2.23), and PCI (aOR 2.02, 95% CI 1.81-2.25); but lower rates of bystander CPR (aOR 0.90, 95% CI 0.87-0.94). We identified numerous performance outlier hospitals; 39 for TTM, 34 for PCI, 9 for survival to discharge, and 24 for survival with good neurologic function. Post-arrest care varied widely across Texas hospitals. Hospitals with higher rates of survival to discharge had increased rates of TTM, LHC, and PCI but not bystander CPR.
Sections du résumé
Background
UNASSIGNED
Large variation exists for out-of-hospital-cardiac-arrest (OHCA) prehospital care, but less is known about variations in post-arrest care. We sought to evaluate variation in post-arrest care in Texas as well as factors associated with higher performing hospitals.
Methods
UNASSIGNED
We analyzed data in Texas Cardiac Arrest Registry to Enhance Survival (TX-CARES), including all adult, non-traumatic OHCAs from 1/1/2014 through 12/31/ 2020 that survived to hospital admission. We first evaluated variability in provisions of post-arrest care and outcomes. We then stratified hospitals into quartiles based on their rate of survival and evaluated the association between improving quartiles and care. Lastly, we evaluated for outliers in post-arrest care and outcomes using a mixed-effect regression model.
Results
UNASSIGNED
We analyzed 7,842 OHCAs admitted to 146 hospitals. We identified large variations in post-arrest care, including targeted temperature management (TTM) (IQR 7.0-51.1%), left heart catheterization (LHC) (IQ 0-25%), and percutaneous coronary intervention (PCI) (IQR 0-10.3%). Higher performing hospital quartiles were associated with higher rates of TTM (aOR 1.42, 95% CI 1.36-1.49), LHC (aOR 2.07, 95% CI 1.92-2.23), and PCI (aOR 2.02, 95% CI 1.81-2.25); but lower rates of bystander CPR (aOR 0.90, 95% CI 0.87-0.94). We identified numerous performance outlier hospitals; 39 for TTM, 34 for PCI, 9 for survival to discharge, and 24 for survival with good neurologic function.
Conclusions
UNASSIGNED
Post-arrest care varied widely across Texas hospitals. Hospitals with higher rates of survival to discharge had increased rates of TTM, LHC, and PCI but not bystander CPR.
Identifiants
pubmed: 35434670
doi: 10.1016/j.resplu.2022.100231
pii: S2666-5204(22)00031-5
pmc: PMC9005946
doi:
Types de publication
Journal Article
Langues
eng
Pagination
100231Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022 The Authors.
Déclaration de conflit d'intérêts
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Références
N Engl J Med. 2002 Feb 21;346(8):557-63
pubmed: 11856794
Ann Emerg Med. 2009 Nov;54(5):674-683.e2
pubmed: 19394110
Resuscitation. 2018 Apr;125:22-27
pubmed: 29408303
J Am Coll Cardiol. 2012 Jul 3;60(1):21-7
pubmed: 22742398
N Engl J Med. 2015 Jun 11;372(24):2307-15
pubmed: 26061835
West J Emerg Med. 2014 Nov;15(7):758-63
pubmed: 25493115
Crit Care Med. 2011 Jan;39(1):84-8
pubmed: 20959784
Circulation. 2010 Feb 9;121(5):709-29
pubmed: 20075331
Circulation. 2016 May 31;133(22):2159-68
pubmed: 27081119
Circulation. 2021 Feb 23;143(8):e254-e743
pubmed: 33501848
Circ Cardiovasc Qual Outcomes. 2010 Jan;3(1):63-81
pubmed: 20123673
Acad Emerg Med. 2005 Oct;12(10):941-7
pubmed: 16204138
J Am Heart Assoc. 2016 Jan 07;5(1):
pubmed: 26744380
Circulation. 2000 Aug 22;102(8 Suppl):I358-70
pubmed: 10966681
Resuscitation. 2012 Jul;83(7):862-8
pubmed: 22353637
Resuscitation. 2017 Jan;110:169-175
pubmed: 27658654
Circulation. 2018 May 22;137(21):e645-e660
pubmed: 29483084
N Engl J Med. 2013 Dec 5;369(23):2197-206
pubmed: 24237006
Resuscitation. 2009 Jan;80(1):30-4
pubmed: 18952359
Resuscitation. 2017 Jan;110:42-47
pubmed: 27816529
N Engl J Med. 2019 Dec 12;381(24):2327-2337
pubmed: 31577396
Prehosp Emerg Care. 2022 Mar-Apr;26(2):204-211
pubmed: 33779479
Circ Cardiovasc Interv. 2010 Jun 1;3(3):200-7
pubmed: 20484098
MMWR Surveill Summ. 2011 Jul 29;60(8):1-19
pubmed: 21796098
Crit Care Med. 2006 Jul;34(7):1935-40
pubmed: 16691134
Circulation. 2011 Mar 1;123(8):877-86
pubmed: 21321156
N Engl J Med. 2021 Jun 17;384(24):2283-2294
pubmed: 34133859
Resuscitation. 2013 Nov;84(11):1536-9
pubmed: 23916552
Resuscitation. 2017 Nov;120:77-87
pubmed: 28888810
Resuscitation. 2005 Feb;64(2):181-6
pubmed: 15680527
Circulation. 2020 Mar 3;141(9):e139-e596
pubmed: 31992061
Resuscitation. 2019 Apr;137:78-86
pubmed: 30771450
Ann Intern Med. 2010 Jul 6;153(1):19-22
pubmed: 20516307
JAMA Cardiol. 2018 Oct 1;3(10):989-999
pubmed: 30267053
JAMA Cardiol. 2021 Mar 1;6(3):296-303
pubmed: 33188678
Circulation. 2014 Nov 18;130(21):1883-90
pubmed: 25399397