Variation in outcomes among 24/7 percutaneous coronary intervention centres for patients resuscitated from out-of-hospital cardiac arrest

Mumma, Bryn E.; Wilson, Machelle; García-Pintos, María Florencia; Erramouspe, Pablo Joaquin; Tancredi, Daniel J.

doi:10.1016/j.resuscitation.2018.12.015

Cited by 2 publications

(2 citation statements)

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“…Mumma et al reported significant variation in good neurological recovery following OHCA between 128 hospitals where PCI is available 24 hours/7 days in California, USA. Multivariable hierarchical logistic regression models were constructed (adjusted rates of good neurological recovery, 18% to 39%; p<0.001) 28. Our present study corroborated this prior study and confirmed the between-hospital variation in survival and functional outcome after OHCA in different healthcare settings.…”

Section: Discussionsupporting

confidence: 88%

“…The between-hospital variation might result from the hospital characteristics that prior studies reported, such as OHCA case volume,17–19 29 30 and cath-lab availability (24/7 PCI or limited PCI capability) 30–32. However, in Mumma’s study, the between-hospital variation in good neurological recovery following OHCA existed even though hospitals with similar characteristics (24/7 PCI centre) were incorporated 28. These results suggest that there were unmeasured hospital characteristics causing the between-hospital variation.…”

Section: Discussionmentioning

confidence: 92%

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Variation in survival after out-of-hospital cardiac arrest between receiving hospitals in Japan: an observational study

et al. 2019

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ObjectivesPatient outcomes after out-of-hospital cardiac arrest (OHCA) varies at multilevel (geographical regions, emergency medical service agencies and receiving hospitals) in the USA. However, it remains unclear whether there is a variation in patient outcomes after OHCA between relevant units of the healthcare system such as receiving hospitals in Japan. Therefore, we aimed to quantify the variation in patient outcomes after OHCA between receiving hospitals in Japan.DesignSecondary analysis of the prospective multicentre OHCA registry.SettingThe Japan Association for Acute Medicine OHCA Registry, a prospective multicentre OHCA registry, including 73 medical institutions in Japan.Participants9303 adults (≥18 years old) with OHCA of medical origin, treated at 67 hospitals from June 2014 to December 2015.Primary and secondary outcome measuresThe primary outcome was 1-month survival after OHCA. The secondary outcome was favourable functional status at 1 month, defined as cerebral performance category scale 1 or 2. We constructed a series of multivariable hierarchical logistic regression models predicting outcomes, accounting for patient-level variables and clustering of patients within hospitals. We evaluated the adjusted 1-month survival and functional outcome for each hospital, ranked hospitals for each outcome and calculated median ORs (MORs) to quantify the between-hospital variation in outcomes.ResultsThe prevalence of 1-month survival after OHCA was 7.1% (663/9303) and that of favourable functional outcome was 3.6% (331/9303). After adjustment for patient-level factors, we observed variations in 1-month survival (range, 1.6%–13.8%; adjusted MOR 1.34; 95% CI 1.16 to 1.67) and favourable functional outcome (range, 0.7%–7.3%; adjusted MOR 1.53; 95% CI 1.10 to 2.24) between hospitals.ConclusionsWe found substantial variations in patient outcomes after OHCA within a large group of hospitals in Japan, despite adjustment for patient factors that are known to be associated with different outcomes.

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Section: Discussionsupporting

confidence: 88%