Relationship Between Institutional Volume of Out-of-Hospital Cardiac Arrest Cases and 1-Month Neurologic Outcomes: A Post Hoc Analysis of a Prospective Observational Study

Kashiura, Masahiro; Amagasa, Shunsuke; Moriya, Takuya; Sakurai, Atsushi; Kitamura, Nobuya; Tagami, Takashi; Takeda, Munekazu; Miyake, Yoshihiro; Inokuchi, Sadaki; Masui, Yoshihiro; Miura, Keita; Tsutsumi, Haruhiko; Takuma, Kiyotsugu; Atsushi, Ishihara; Nakano, Minoru; Tanaka, Hiroshi; Ikegami, Keiichi; Arai, Takao; Yaguchi, Arino; Oda, Shinya; Kobayashi, Kenji; Suda, Takayuki; Ono, Katsushige; Morimura, Naoto; Furuya, Ryosuke; Koido, Yuichi; Iwase, Fumiaki; Nagao, Ken; Kanesaka, Shigeru; Okada, Yoshinori; Unemoto, Kyoko; Sadahiro, Tomohito; Iyanaga, Masayuki; Muraoka, Asaki; Hayashi, Mitsuhiro; Ishimatsu, Shinichi; Yokokawa, Hideo; Koyama, Yoshinori; Tsuchiya, Asuka; Kashiyama, Tetsuya; Hayashi, Masanori; Oshima, Kiyohiro; Kiyota, Kazuya; Hamabe, Yuichi; Hori, Shingo; Inaba, Susumu; Sakamoto, Tetsuya; Harada, Naoshige; Kimura, Akio; Kanai, Masayuki; Otomo, Yasuhiro; Sugita, Manabu; Kinoshita, Kosaku; Sakurai, Takatoshi; Kitano, Mitsuhide; B, Kiyoshi F.; Tanaka, Kotaro; Yoh, Kikuo; Suzuki, Junichi; Toyoda, Hiroshi; Mashiko, Kunihiro; Shimizu, Naoki; Muguruma, Takashi; Shimada, Tadanaga; Kobe, Yoshiro; Shoko, Tomohisa; Nakanishi, Koji; Shiga, Takashi; Yamamoto, Takefumi; Sekine, Keitaro; Izuka, Shinichi

doi:10.1016/j.jemermed.2020.04.039

Cited by 8 publications

(23 citation statements)

References 36 publications

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“…This result remained significant when using a fixed‐effects model (aOR, 1.92 [95% CI, 1.74–2.11]). On sensitivity analysis, pooled estimates also revealed a significant increase in this outcome among patients treated at CACs when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]; Figure 6A ) 20 , 40 , 45 , 57 , 62 , 64 , 65 , 66 , 67 and also when including centers with improved postresuscitation care in the definition of CAC (aOR, 1.97 [95% CI, 1.71–2.26]; Figure 6B ). ¶ When using fixed‐effects models, these results remained significant when including high‐volume centers (aOR, 1.77 [95% CI, 1.63–1.92]) or centers with improved postresuscitation care (aOR, 1.95 [95% CI, 1.79–2.12]).…”

Section: Resultsmentioning

confidence: 97%

“…The κ value measuring interrater reliability was 0.75 when reviewing the title and abstracts and 0.9 for full‐text review. Finally, 36 studies 20 , 23 , 24 , 25 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 qualified for analysis. The study selection process and reasons for excluding the 54 studies are illustrated in the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses‐P 2020 flow diagram (Figure 1 ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 147 943 patients were included in the 36 studies. Two studies 55 , 67 were conducted in Australia, 1 in Canada 66 , 1 in the Czech Republic, 60 2 in Denmark, 47 , 53 1 in France, 56 5 in Japan, 24 , 44 , 50 , 58 , 64 8 in South Korea, 40 , 42 , 46 , 48 , 49 , 51 , 62 , 63 1 in Norway, 37 4 in Taiwan, 23 , 45 , 65 , 68 2 in the United Kingdom, 20 , 59 and 9 § in the United States. Three articles reported data from the CARES (Cardiac Arrest Registry to Enhance Survival) registry, 2 articles from the CAVAS database (Cardiovascular Disease Surveillance), 2 articles from the NHIRD database (National Health Insurance Research), and 3 articles from the UOP (Utstein Osaka Project).…”

Section: Resultsmentioning

confidence: 99%

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Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Yeo

Goh

et al. 2022

JAHA

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Background The role of cardiac arrest centers (CACs) in out‐of‐hospital cardiac arrest care systems is continuously evolving. Interpretation of existing literature is limited by heterogeneity in CAC characteristics and types of patients transported to CACs. This study assesses the impact of CACs on survival in out‐of‐hospital cardiac arrest according to varying definitions of CAC and prespecified subgroups. Methods and Results Electronic databases were searched from inception to March 9, 2021 for relevant studies. Centers were considered CACs if self‐declared by study authors and capable of relevant interventions. Main outcomes were survival and neurologically favorable survival at hospital discharge or 30 days. Meta‐analyses were performed for adjusted odds ratio (aOR) and crude odds ratios. Thirty‐six studies were analyzed. Survival with favorable neurological outcome significantly improved with treatment at CACs (aOR, 1.85 [95% CI, 1.52–2.26]), even when including high‐volume centers (aOR, 1.50 [95% CI, 1.18–1.91]) or including improved‐care centers (aOR, 2.13 [95% CI, 1.75–2.59]) as CACs. Survival significantly increased with treatment at CACs (aOR, 1.92 [95% CI, 1.59–2.32]), even when including high‐volume centers (aOR, 1.74 [95% CI, 1.38–2.18]) or when including improved‐care centers (aOR, 1.97 [95% CI, 1.71–2.26]) as CACs. The treatment effect was more pronounced among patients with shockable rhythm ( P =0.006) and without prehospital return of spontaneous circulation ( P =0.005). Conclusions were robust to sensitivity analyses, with no publication bias detected. Conclusions Care at CACs was associated with improved survival and neurological outcomes for patients with nontraumatic out‐of‐hospital cardiac arrest regardless of varying CAC definitions. Patients with shockable rhythms and those without prehospital return of spontaneous circulation benefited more from CACs. Evidence for bypassing hospitals or interhospital transfer remains inconclusive.

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Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Yeo

Goh

et al. 2022

JAHA

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“…A fairly substantial evidence base has accumulated over the past decade supporting key features of CACs related to regionalization, including individual interventions such as TTM [35], 24/7 PCI [36], ECMO [37], and prognostication [38,39], a structured OHCA treatment bundle combining the above [40,41], and highvolume centres [42]. It should be acknowledged, however, that there continues to be active debate in these research areas, such as what specific temperature should be aimed for in TTM [43], and why some high-volume centres have relatively poor outcomes [20].…”

Section: Key Pointsmentioning

confidence: 99%

Cardiac arrest centres: what, who, when, and where?

Yeo

Ong

2022

Current Opinion in Critical Care

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Purpose of reviewCardiac arrest centres (CACs) may play a key role in providing postresuscitation care, thereby improving outcomes in out-of-hospital cardiac arrest (OHCA). There is no consensus on CAC definitions or the optimal CAC transport strategy despite advances in research. This review provides an updated overview of CACs, highlighting evidence gaps and future research directions.Recent findingsCAC definitions vary worldwide but often feature 24/7 percutaneous coronary intervention capability, targeted temperature management, neuroprognostication, intensive care, education, and research within a centralized, high-volume hospital. Significant evidence exists for benefits of CACs related to regionalization. A recent meta-analysis demonstrated clearly improved survival with favourable neurological outcome and survival among patients transported to CACs with conclusions robust to sensitivity analyses. However, scarce data exists regarding ‘who’, ‘when’, and ‘where’ for CAC transport strategies. Evidence for OHCA patients without ST elevation postresuscitation to be transported to CACs remains unclear. Preliminary evidence demonstrated greater benefit from CACs among patients with shockable rhythms. Randomized controlled trials should evaluate specific strategies, such as bypassing nearest hospitals and interhospital transfer.SummaryReal-world study designs evaluating CAC transport strategies are needed. OHCA patients with underlying culprit lesions, such as those with ST-elevation myocardial infarction (STEMI) or initial shockable rhythms, will likely benefit the most from CACs.

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“…Therefore, recommendations suggesting criteria for cardiac-arrest hospitals have been published [8]. However, the relationship between hospital volume and prognosis in patients with OHCA is inconclusive, since some studies have demonstrated improved prognosis at high-volume hospitals [9][10][11][12][13], while others did not report any such improvement [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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

Tsuchida,

Ono,

Maekawa

et al. 2022

Preprint

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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 3,632 of 35,754 patients hospitalized for cardiac OHCA 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: The 30-day survival rate after admission was not correlated with hospital volume in all cardiac OHCA patients and subgroups. However, the frequency of favorable neurological outcomes in cardiac OHCA patients with ROSC before arrival at the emergency department at high-volume centers was higher than those at medium- and low-volume centers. Conclusion: Hospital volume did not significantly affect the prognosis of adult patients with cardiac OHCA. However, transport to a high-volume hospital may improve the neurological prognosis in cardiac OHCA patients with ROSC before arrival at the emergency department.

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Relationship Between Institutional Volume of Out-of-Hospital Cardiac Arrest Cases and 1-Month Neurologic Outcomes: A Post Hoc Analysis of a Prospective Observational Study

Cited by 8 publications

References 36 publications

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Impact of Cardiac Arrest Centers on the Survival of Patients With Nontraumatic Out‐of‐Hospital Cardiac Arrest: A Systematic Review and Meta‐Analysis

Cardiac arrest centres: what, who, when, and where?

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

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