Variability in survival and post-cardiac arrest care following successful resuscitation from out-of-hospital cardiac arrest

Abstract Aim of the study Regionalization of care for out-of-hospital cardiac arrests (OHCA) may improve patient outcomes. We evaluated inter-hospital variations in post-arrest care provision and the relation between hospital case volume and survival in Pennsylvania. Methods This retrospective study (2013–2017) used data from adult OHCA cases in Pennsylvania from the Cardiac Arrest Registry to Enhance Survival. Analysis was performed on hospitals reporting greater than 40 cases/5 years with sustained return of spontaneous circulation upon emergency department arrival and survival to hospital admission. We compared post-arrest treatments across hospitals stratified into arrest volume quartiles. Logistic regression models were used to assess the volume-outcome relationship. Results We analyzed 3512 OHCAs admitted to 48 hospitals. Survival to discharge (24–65%) and neurological recovery (15–56%) were highly varied between hospitals. Compared to lower performing hospitals, hospitals with higher survival rates (≥ 40%) performed significantly more coronary angiographies (32% vs. 26%), stenting (17.5% vs. 13%), and ICD placements (12.5% vs 7.4%). Across volume quartiles, no significant differences were found in percent of treatment provision or outcomes. After adjustment for patient demographics, prehospital and post-arrest care variables, odds of survival and neurological recovery were 43% (OR 1.43; 95% CI, 1.08–1.89) and 51% (OR 1.51; 95% CI, 1.11–2.04) higher in hospitals with greater receiving volumes, respectively. Conclusions Hospital case volume is associated with improved patient outcomes. Inter-hospital variability in OHCA outcomes may potentially be addressed by regionalization of care to high volume centers with higher rates of post-arrest care provision and better patient outcomes.