Resuscitation plus · 2024
Regional variation in temperature control after out-of-hospital cardiac arrest.
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Meitlis Iana, Hall Jane, Gunaje Navya, Parayil Megin, Yang Betty Y, Danielson Kyle, Counts Catherine R, Drucker Christopher, Maynard Charles, Rea Thomas D, Kudenchuk Peter J, Sayre Michael R, Johnson Nicholas J
Аннотация
INTRODUCTION: We evaluated hospitals for variation in temperature control (TC) use after out-of-hospital cardiac arrest (OHCA) in a regional emergency medical services system and assessed association of hospital-level TC utilization with survival.
METHODS: A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment.
RESULTS: Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3-2.3]), witnessed arrest (OR: 1.6 [1.2-2.2]), and shockable rhythm (OR: 5.5 [3.9-7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4-0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital.
CONCLUSIONS: Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.
METHODS: A retrospective cohort study of adults with non-traumatic OHCA who survived to hospital admission from 2016 to 2018 in King County, Washington. Hospitals with < 80 OHCA cases were excluded. Primary exposure was hospital-level proportion of TC. Measured outcomes were survival to hospital discharge and neurologically favorable survival (defined as Cerebral Performance Category 1 or 2). Logistic regression modeling clustered patients by treating hospital and evaluated associations between TC and outcomes with covariate adjustment.
RESULTS: Of 1,035 eligible patients admitted to eight hospitals, 69% were male, 38% had an initial shockable rhythm, and 61% had presumed cardiac etiology for OHCA. TC was initiated in 787 patients (74%) and ranged from 57 to 87% across hospitals. Overall, 34% of patients survived neurologically intact, 74% of whom received TC. In the adjusted model, public OHCA location (OR: 1.7 [95% CI 1.3-2.3]), witnessed arrest (OR: 1.6 [1.2-2.2]), and shockable rhythm (OR: 5.5 [3.9-7.8]) were more strongly associated with survival than TC utilization (OR: 0.6 [0.4-0.8]). Similar results were seen for neurologically favorable survival and did not vary significantly by hospital.
CONCLUSIONS: Hospital-level TC utilization was not associated with improved survival or neurologically favorable survival after OHCA. Future studies should examine which aspects of the post-cardiac arrest care bundle most strongly influence outcomes.