280 Treatment at High-Volume Cardiac Arrest Centers is Associated With Better Neurologic Outcome After Out-of-Hospital Cardiac Arrest

Abstract

Regionalization with increased patient volume has improved outcomes for multiple disease processes. The purpose of this study was to evaluate the relationship between volume and outcome from out-of-hospital cardiac arrest (OHCA). This is a retrospective study of patients treated for OHCA in a regionalized system. All patients with return of spontaneous circulation (ROSC) are transported to a cardiac arrest receiving center. Hospitals report outcomes to a single registry, from which adult patients from 2011 to 2014 were abstracted. The median monthly cardiac arrest volume by hospital was calculated. High-volume hospitals (above the median) were compared to low-volume hospitals (below the median). The primary outcome was survival to hospital discharge with good neurologic outcome, defined as cerebral performance category (CPC) 1 or 2. Secondary outcomes were frequency of targeted temperature management (TTM), coronary angiography, and percutaneous coronary intervention (PCI). The median hospital volume was 3 (IQR 2-4) OHCA per month. There were 5178 patients in the registry, 3315 patients treated at 16 high-volume centers and 1863 treated at 19 low-volume centers. The groups were similar, with the exception of a slightly higher proportion of patients with initial shockable rhythm at high-volume centers (31% vs 28%) and fewer witnessed arrests (81% vs 85%). There was no difference in survival to hospital discharge (36% in both groups). However, survival with good neurologic outcome was higher at high-volume versus low-volume centers (22% vs 19%, Risk Difference (RD) 3% 95% CI 1-5%). Among survivors, there was significantly improved neurologic outcome (61% vs 52%, RD 9% 4-13%). High-volume centers had higher use of TTM (39% vs 34%, RD 5% 95% CI 2-7%). There was no difference in coronary angiography or PCI, 20% and 10% respectfully in both groups. In this system, treatment at high-volume centers was associated with improved survival with good neurologic outcome after OHCA.