Abstract 324: Out-of-hospital Cardiac Arrest Intervention and Outcome Variation in Detroit

Abstract

Introduction: Significant variation exists in treatment and outcomes from out-of-hospital cardiac arrest (OHCA). Disparities between hospitals serving a similar population is less known. Hypothesis: OHCA post-resuscitation practices and outcomes differ significantly between 4 hospitals in Detroit, which serve a similar population. Methods: The Detroit-Cardiac Registry to Enhance Survival were analyzed between January 1st, 2014 to December 31st, 2019. Patients <18 years age, had a pre-existing DNR, and those transferred to another facility were excluded. 4 tertiary care hospitals (median distance: 10.6 miles) were compared on utilization of 2 treatment decisions (coronary angiography, new DNR order) and 2 clinical outcomes (cerebral performance category {CPC} ≤ 2, in-hospital death) using logistic regression models adjusted for known confounders. Models for death and CPC outcome were tested with vs. without the addition of angiography and DNR initiation as additional confounders (sensitivity analysis). Results: 999-included patients at hospitals A - D differed (p<0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-ED time, TTM, coronary angiography, DNR order, and in-hospital death, but not CPC ≤ 2. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to all others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR=0.17) and was more likely to initiate new DNR status than B (OR=2.9), C (OR=16.1), or D (OR=3.6). Multivariable-adjusted odds of CPC ≤ 2 were worse in Hospital A compared to B (OR=0.27) and D (OR=0.35). After sensitivity analysis for the different treatment propensities, CPC ≤ 2 odds did not differ for A versus B (OR=0.58, adjusted for angiography) or D (OR=0.65, adjusted for DNR order). Multivariable-adjusted odds of death, regardless of angiography and DNR differences, were worse in Hospital A compared to B (OR=1.87) and D (OR=1.81). Conclusion: OHCA treatment and outcome disparities were noted between nearby Detroit hospitals serving related patient populations. Rates of coronary angiography and DNR orders partially explain disparities in CPC <2 but not death.