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^{1

2}, Christine W Lary³, Richard R Riker⁴, Hans Friberg⁵, Nainesh Patel⁶, Eldar Søreide^{7

8}, John A McPherson⁹, Johan Undén^{10

11}, Robert Hand¹², Kjetil Sunde^{13

14}, Pascal Stammet¹⁵, Stein Rubertsson¹⁶, Jan Belohlvaek¹⁷, Allison Dupont¹⁸, Karen G Hirsch¹⁹, Felix Valsson²⁰, Karl Kern²¹, Farid Sadaka²², Johan Israelsson²³, Josef Dankiewicz^{9

24}, Niklas Nielsen²⁵, David B Seder⁴, Sachin Agarwal²⁶

Affiliations

¹ Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA. tmay@mmc.org.
² Clinical and Translational Science Institute, Tufts University, Boston, ME, 02111, USA. tmay@mmc.org.
³ Center for Outcomes Research, Maine Medical Center, Portland, ME, USA.
⁴ Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
⁵ Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
⁶ Division of Cardiovascular Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA.
⁷ Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.
⁸ Department Clinical Medicine, University of Bergen, Bergen, Norway.
⁹ Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁰ Department of Clinical Sciences, Lund University, Getingevägen, 22185, Lund, Sweden.
¹¹ Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
¹² Department of Critical Care, Eastern Maine Medical Center, Bangor, ME, USA.
¹³ Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁵ Medical Department National Rescue Services, Luxembourg, 14, rue Stümper, 2557, Luxembourg, Luxembourg.
¹⁶ Department of Surgical Sciences/Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
¹⁷ Department of Internal Medicine II, Cardiovascular Medicine, General Teaching Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic.
¹⁸ Department of Cardiology, Northeast Georgia Medical Center, Gainesville, Georgia, USA.
¹⁹ Stanford Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
²⁰ Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykyavik, Iceland.
²¹ Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, USA.
²² Mercy Hospital St Louis, St Louis University, St. Louis, MO, USA.
²³ Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden.
²⁴ Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
²⁵ Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
²⁶ Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY, USA.

PMID: 30848327
PMCID: PMC6486427
DOI: 10.1007/s00134-019-05580-7

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 et al. Intensive Care Med. 2019 May.

. 2019 May;45(5):637-646.

doi: 10.1007/s00134-019-05580-7. Epub 2019 Mar 8.

Authors

Affiliations

¹ Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA. tmay@mmc.org.
² Clinical and Translational Science Institute, Tufts University, Boston, ME, 02111, USA. tmay@mmc.org.
³ Center for Outcomes Research, Maine Medical Center, Portland, ME, USA.
⁴ Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA.
⁵ Department of Anesthesia and Intensive Care, Skåne University Hospital, Lund University, Lund, Sweden.
⁶ Division of Cardiovascular Medicine, Lehigh Valley Hospital and Health Network, Allentown, PA, USA.
⁷ Critical Care and Anesthesiology Research Group, Stavanger University Hospital, Stavanger, Norway.
⁸ Department Clinical Medicine, University of Bergen, Bergen, Norway.
⁹ Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
¹⁰ Department of Clinical Sciences, Lund University, Getingevägen, 22185, Lund, Sweden.
¹¹ Department of Intensive and Perioperative Care, Skåne University Hospital, Malmö, Sweden.
¹² Department of Critical Care, Eastern Maine Medical Center, Bangor, ME, USA.
¹³ Department of Anaesthesiology, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway.
¹⁴ Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
¹⁵ Medical Department National Rescue Services, Luxembourg, 14, rue Stümper, 2557, Luxembourg, Luxembourg.
¹⁶ Department of Surgical Sciences/Anesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden.
¹⁷ Department of Internal Medicine II, Cardiovascular Medicine, General Teaching Hospital and 1st Medical School, Charles University in Prague, Prague, Czech Republic.
¹⁸ Department of Cardiology, Northeast Georgia Medical Center, Gainesville, Georgia, USA.
¹⁹ Stanford Neurocritical Care Program, Department of Neurology and Neurological Sciences, Stanford University School of Medicine, Stanford, CA, USA.
²⁰ Department of Anesthesia and Intensive Care, Landspitali University Hospital, Reykyavik, Iceland.
²¹ Division of Cardiology, Sarver Heart Center, University of Arizona, Tucson, USA.
²² Mercy Hospital St Louis, St Louis University, St. Louis, MO, USA.
²³ Department of Internal Medicine, Division of Cardiology, Kalmar County Hospital, Kalmar, Sweden.
²⁴ Department of Intensive and Perioperative Care, Skåne University Hospital, Lund, Sweden.
²⁵ Department of Clinical Sciences, Anesthesia and Intensive Care, Lund University, Helsingborg Hospital, Helsingborg, Sweden.
²⁶ Department of Neurology, Columbia-Presbyterian Medical Center, New York, NY, USA.

PMID: 30848327
PMCID: PMC6486427
DOI: 10.1007/s00134-019-05580-7

Erratum in

Correction to: Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry.
May TL, Lary CW, Riker RR, Friberg H, Patel N, Søreide E, McPherson JA, Undén J, Hand R, Sunde K, Stammet P, Rubertsson S, Belohlvaek J, Dupont A, Hirsch KG, Valsson F, Kern K, Sadaka F, Israelsson J, Dankiewicz J, Nielsen N, Seder DB, Agarwal S. May TL, et al. Intensive Care Med. 2019 Aug;45(8):1176. doi: 10.1007/s00134-019-05687-x. Intensive Care Med. 2019. PMID: 31317207

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 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.

Keywords: Cardiac arrest; Center variability; Out of hospital arrest.

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Figures

**Figure 1:**
Good outcome at hospital discharge by center after risk adjustment.

**Figure 2:**
Good outcome at follow-up by center after risk adjustment.

See this image and copyright information in PMC

References

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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

Affiliations

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

Authors

Affiliations

Erratum in

Abstract

Figures

References

MeSH terms

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Full Text Sources