Characteristics, management, and prognosis of out-of-hospital cardiac arrest of cardiac cause according to the treating center.

OBJECTIVE

Out-of-hospital cardiac arrest (OHCA) is a major public health problem associated with high mortality and disability. Hospital care in Spain is heterogeneous. This study analyzes the impact of hospital type and interhospital transfers on the management and prognosis of patients with OHCA.

METHODS

We conducted a retrospective, population-based study (2016-2022) was using the Minimum Basic Data Set of patients aged > 18 years with a diagnosis of OHCA due to an underlying cardiac cause. Episodes were categorized into 3 groups: admission to hospitals without (Group 1) and with (Group 3) a cath lab; and Group 2: transfer from a Group 1 hospital to a Group 3 hospital. Outcome variables included in-hospital mortality and cerebral anoxia. Multilevel logistic regression models were used for risk adjustment.

RESULTS

A total of 6,379 episodes were analyzed. The overall mortality rate was 42.7%. Cerebral anoxia (OR, 5.8; 95% CI, 4.97-6.88) and chronic liver disease (OR, 2.61; 95% CI, 1.88-3.61) were the main predictors of mortality. Belonging to Group 2 (OR, 0.27; 95% CI, 0.17-0.41) and Group 3 (OR, 0.81; 95% CI, 0.68 0.96) had a protective effect. Centers with a higher number of discharges for circulatory system diseases showed a lower risk-adjusted mortality rate.

CONCLUSIONS

There are differences in the hospital management of OHCA in Spain. The availability of PCI capable centers and a higher volume of circulatory system cases offer a better prognosis. The limited centralization of care suggests opportunities for organizational improvement to optimize outcomes.