Hospital post-cardiac arrest patient volume and key features of post-cardiac arrest care
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Background: Hospitals vary in the number of out-of-hospital cardiac arrest (OHCA) patients they treat on an annual basis. Institutional experience with this type of complex patient may be associated with the quality of post-arrest care delivered by a hospital, specifically targeted temperature management (TTM). Objectives: 1) To quantify the variability in post-cardiac arrest patient characteristics, treatments, and outcomes across a network of 37 hospitals in Southern Ontario, 2) To evaluate the association between average annual hospital volume of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrest and several care process and clinical outcomes. Methods: This was a retrospective, population-based cohort study of consecutive non-traumatic OHCA cases presenting to the 37 hospitals in the Strategies for Post-Arrest Care Network of Southern Ontario from 2007-2013. The study included adult patients who achieved return of spontaneous circulation, survived at least 6 hours post-hospital arrival and were comatose. The study excluded patients with a pre-existing Do-Not-Resuscitate order, who had life sustaining therapy withdrawn within 6 hours of hospital arrival, and who had intracranial or severe bleeding within 6 hours of hospital arrival. The patient population was described and the proportion of patients who achieved specific care-process and clinical outcomes were reported by hospital volume. Several multi-level logistic regression models were constructed with patients (level 1) nested within hospitals (level 2). Results: The cohort included 2,723 eligible patients at 37 hospitals. Overall, 33% had successful TTM. Successful TTM varied significantly between 3 hospital volume groups (26% (184/721) for <15 patients/year, 33% (342/1024) for 15-25 patients/year, and 38% (369/978) for >25 patients/year; p<0.05). The volume groups were comparable on patient factors. The intraclass correlation coefficient demonstrated 11% of the variability in successful TTM was attributable to hospital-level factors. Multilevel analysis revealed for each 10 unit increase in annual volume of patients eligible for TTM, the adjusted odds for successful TTM were almost 30% higher (OR 1.29, CI95 1.03-1.62). Conclusions: Successful TTM varied markedly between hospitals on the basis of experience with post-OHCA patients. Patients who received successful TTM were more likely to have arrived at hospitals with more experience in post-OHCA patients.