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. 2022 Jul 7;22(1):121.
doi: 10.1186/s12873-022-00685-7.

Effect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest

Takumi Tsuchida  1 , Kota Ono  2 , Kunihiko Maekawa  3 , Mariko Hayamizu  3 , Mineji Hayakawa  3
Affiliations

Effect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest

Takumi Tsuchida et al. BMC Emerg Med. .

Abstract

Background: Although the prognosis of patients treated at specialized facilities has improved, the relationship between the number of patients treated at hospitals and prognosis is controversial and lacks constancy in those with out-of-hospital cardiac arrest (OHCA). This study aimed to clarify the effect of annual hospital admissions on the prognosis of adult patients with OHCA by analyzing a large cohort.

Methods: The effect of annual hospital admissions on patient prognosis was analyzed retrospectively using data from the Japanese Association for Acute Medicine OHCA registry, a nationwide multihospital prospective database. This study analyzed 3632 of 35,754 patients hospitalized for OHCA of cardiac origin at 86 hospitals. The hospitals were divided into tertiles based on the volume of annual admissions. The effect of hospital volume on prognosis was analyzed using logistic regression analysis with multiple imputation. Furthermore, three subgroup analyses were performed for patients with return of spontaneous circulation (ROSC) before arrival at the emergency department, patients admitted to critical care medical centers, and patients admitted to extracorporeal membrane oxygenation-capable hospitals.

Results: Favorable neurological outcomes 30 days after OHCA for patients overall showed no advantage for medium- and high-volume centers over low-volume centers; Odds ratio (OR) 0.989, (95% Confidence interval [CI] 0.562-1.741), OR 1.504 (95% CI 0.919-2.463), respectively. However, the frequency of favorable neurological outcomes in OHCA patients with ROSC before arrival at the emergency department at high-volume centers was higher than those at low-volume centers (OR 1.955, 95% CI 1.033-3.851).

Conclusion: Hospital volume did not significantly affect the prognosis of adult patients with OHCA. However, transport to a high-volume hospital may improve the neurological prognosis in OHCA patients with ROSC before arrival at the emergency department.

Keywords: Cardiopulmonary resuscitation; Hospital volume; Neurological outcome; Out-of-hospital cardiac arrest; Prediction; Prognosis.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of patient enrollment in this study. The n in the figure indicates the number of patients. OHCA: out-of-hospital cardiac arrest, ECG: electrocardiography, ROSC: return of spontaneous circulation, EMS: emergency medical services
Fig. 2
Fig. 2
Adjusted odds ratio for favorable neurological outcomes 30 days after OHCA. Odds ratio of middle-volume hospitals and high-volume hospitals to low-volume hospital (reference) for favorable neurological outcomes 30 days after hospitalization. “n” in the figure indicates the number of patients. The number in “[]” represents the number of people who actually had a favorable neurological outcome. CI: confidence interval, ROSC: return of spontaneous circulation, ECMO: extracorporeal membrane oxygenation, OHCA: out-of-hospital cardiac arrest
Fig. 3
Fig. 3
Adjusted odds ratio for 30-day survival after OHCA. Odds ratio of middle-volume hospitals and high-volume hospitals to low volume hospitals (reference) when the outcome is survival rate after 30 days of hospitalization. “n” in the figure indicates the number of patients. The number in “[]” represents the number of people who actually survived. CI: confidence interval, ROSC: return of spontaneous circulation, ECMO: extracorporeal membrane oxygenation, OHCA: out-of-hospital cardiac arrest
See this image and copyright information in PMC

Comment in

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