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. 2022 Apr 5:10:100231.
doi: 10.1016/j.resplu.2022.100231. eCollection 2022 Jun.

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

Ryan Huebinger  1   2 , Jordan Thomas  3 , Benjamin S Abella  4 , John Waller-Delarosa  1   2 , Rabab Al-Araji  5 , Richard Witkov  1   2 , Normandy Villa  1   2 , Peter Nikonowicz  1 , Taylor Renbarger  2 , Micah Panczyk  1   2 , Bentley Bobrow  1   2
Affiliations

Impact of post-arrest care variation on hospital performance after out-of-hospital cardiac arrest

Ryan Huebinger et al. Resusc Plus. .

Abstract

Background: 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: 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: 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: 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.

Keywords: Cardiac arrest; Out-of-Hospital Cardiac Arrest; PCI; Post-arrest care; TTM.

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Conflict of interest statement

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.

Figures

Fig. 1
Fig. 1
Variations in rate of TTM (top) and PCI (bottom) for each hospital; adjusted for age, gender, race, witnessed cardiac arrest, bystander CPR, and initial shockable rhythm. Red diamonds indicate communities above and below the mean, defined as hospitals with adjusted TTM or PCI rate 95% confidence interval limits falling outside of the overall community mean.
Fig. 2
Fig. 2
Variations in rates of survival (top) and survival with CPC score of 1 or 2 (bottom) for each hospital; adjusted for age, gender, race, witnessed cardiac arrest, bystander CPR, and initial shockable rhythm. Red diamonds indicate hospitals above and below the mean, defined as hospitals with adjusted outcome rate 95% confidence interval limits falling outside of the overall risk-adjusted mean.
See this image and copyright information in PMC

Comment in

  • Editor's Note.
    [No authors listed] [No authors listed] Resusc Plus. 2023 Feb 25;13:100364. doi: 10.1016/j.resplu.2023.100364. eCollection 2023 Mar. Resusc Plus. 2023. PMID: 36915916 Free PMC article. No abstract available.

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