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Multicenter Study
. 2016 Nov:108:48-53.
doi: 10.1016/j.resuscitation.2016.09.008. Epub 2016 Sep 17.

Long-term survival benefit from treatment at a specialty center after cardiac arrest

Jonathan Elmer  1 , Jon C Rittenberger  2 , Patrick J Coppler  3 , Francis X Guyette  2 , Ankur A Doshi  2 , Clifton W Callaway  2 ; Pittsburgh Post-Cardiac Arrest Service
Affiliations
Multicenter Study

Long-term survival benefit from treatment at a specialty center after cardiac arrest

Jonathan Elmer et al. Resuscitation. 2016 Nov.

Abstract

Introduction: The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA).

Methods: We included patients hospitalized at one of 7 medical centers in Southwestern Pennsylvania after SCA from 2005 to 2013. Centers were one regional referral center with an organized systems for post-SCA care, two moderate volume tertiary care centers and 4 low-volume centers. We abstracted clinical characteristics and outcomes at hospital discharge, and for survivors to discharge we queried the National Death Index for long-term survival data. We used Cox regression to determine the unadjusted associations of baseline predictors and survival, and built an adjusted model controlling for baseline predictors.

Results: Overall, 987 patients survived to discharge. During 2196 person-years of follow-up, median survival was 5.3 years and there were 396 deaths. In unadjusted analysis, treating center, age, arrest location, Charlson Comorbidity Index, initial rhythm, cardiac catheterization, defibrillator placement, discharge disposition, and neurological status at discharge were associated with long-term outcome. In adjusted analysis, treatment at the high-volume cardiac arrest center was associated with improved survival compared to treatment at other centers (hazards ratio 1.49, 95% confidence interval 1.19-1.86).

Conclusion: Treatment at a high-volume cardiac arrest center with organized systems for post-arrest care is associated with a substantial long-term survival benefit after hospital discharge.

Keywords: Cardiac arrest; Outcome; Regionalization; Survival.

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Conflict of interest statement

Conflicts of Interest: The other authors report no disclosures.

Figures

Figure 1
Figure 1
Cohort selection process
Figure 2
Figure 2
Kaplan Meier survival estimates for sudden cardiac arrest victims surviving to hospital discharge, stratified according to treating center
See this image and copyright information in PMC

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