Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2021 Sep 10;25(1):329.
doi: 10.1186/s13054-021-03754-8.

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

B Y Gravesteijn  1   2 , M Schluep  3 , H F Lingsma  4 , R J Stolker  3 , H Endeman  5 , S E Hoeks  3 ; ROUTINE-study consortium
Collaborators, Affiliations
Multicenter Study

Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

B Y Gravesteijn et al. Crit Care. .

Abstract

Background: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care.

Methods: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres.

Results: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001).

Conclusion: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.

Keywords: Between-centre differences; Cardiopulmonary resuscitation; Cohort study; In-hospital cardiac arrest; Quality of care.

PubMed Disclaimer

Conflict of interest statement

The authors declare to have no competing interest.

Figures

Fig. 1
Fig. 1
The number of inclusions per participating centre (displayed anonymously) and the primary outcome measure in-hospital mortality per centre
Fig. 2
Fig. 2
The individual effects of each centre on outcome indicators: mortality on the left, and CPC score on the right. The estimates are the random intercept values of a mixed effects model including the predictors in Table 3
Fig. 3
Fig. 3
The individual effects of each centre on process indicators: time to ALS on the left, and reporting any RRS score < 24 h before arrest on the right. The estimates are the random intercept values of a mixed effects model including the predictors in Table 3
Fig. 4
Fig. 4
The CPC scores at discharge, stratified per investigated structure of care indicator. The p value as a result of a Fisher Exact test is displayed above the barcharts. Only patients with known CPC scores are included. For the absolute numbers, see Additional file 1: Table S5
See this image and copyright information in PMC

References

    1. Skogvoll E, Isern E, Sangolt GK, Gisvold SE. In-hospital cardiopulmonary resuscitation. 5 years’ incidence and survival according to the Utstein template. Acta Anaesthesiol Scand. 1999;43:177–184. doi: 10.1034/j.1399-6576.1999.430210.x. - DOI - PubMed
    1. Sandroni C, Nolan J, Cavallaro F, Antonelli M. In-hospital cardiac arrest: incidence, prognosis and possible measures to improve survival. Intensive Care Med. 2007;33:237–245. doi: 10.1007/s00134-006-0326-z. - DOI - PubMed
    1. Hodgetts TJ, Kenward G, Vlackonikolis I, Payne S, Castle N, Crouch R, et al. Incidence, location and reasons for avoidable in-hospital cardiac arrest in a district general hospital. Resuscitation. 2002;54:115–123. doi: 10.1016/S0300-9572(02)00098-9. - DOI - PubMed
    1. Schluep M, Gravesteijn BY, Stolker RJ, Endeman H, Hoeks SE. One-year survival after in-hospital cardiac arrest: a systematic review and meta-analysis. Resuscitation. 2018;132:90–100. doi: 10.1016/j.resuscitation.2018.09.001. - DOI - PubMed
    1. Bradley SM, Kaboli P, Kamphuis LA, Chan PS, Iwashyna TJ, Nallamothu BK. Temporal trends and hospital-level variation of inhospital cardiac arrest incidence and outcomes in the Veterans Health Administration. Am Heart J. 2017;193:117–123. doi: 10.1016/j.ahj.2017.05.018. - DOI - PMC - PubMed

Publication types