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

May, Teresa L.; Lary, Christine W.; Riker, Richard R.; Friberg, Hans LU ; Patel, Nainesh; Søreide, Eldar; McPherson, John A.; Undén, Johan LU ; Hand, Robert and Sunde, Kjetil, et al. (2019) In Intensive Care Medicine
Abstract

Purpose: 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. Methods: 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... (More)

Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.

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@article{3facc6e1-ab32-4ac6-afc5-06cbeea12d8b,
  abstract     = {<p>Purpose: 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. Methods: 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. Results: 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. Conclusions: 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.</p>},
  author       = {May, Teresa L. and Lary, Christine W. and Riker, Richard R. and Friberg, Hans and Patel, Nainesh and Søreide, Eldar and McPherson, John A. and Undén, Johan and Hand, Robert and Sunde, Kjetil and Stammet, Pascal and Rubertsson, Stein and Belohlvaek, Jan and Dupont, Allison and Hirsch, Karen G. and Valsson, Felix and Kern, Karl and Sadaka, Farid and Israelsson, Johan and Dankiewicz, Josef and Nielsen, Niklas and Seder, David B. and Agarwal, Sachin},
  issn         = {0342-4642},
  keyword      = {Cardiac arrest,Center variability,Out of hospital arrest},
  language     = {eng},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest : analysis of International Cardiac Arrest Registry},
  url          = {http://dx.doi.org/10.1007/s00134-019-05580-7},
  year         = {2019},
}