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.
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