Abstract
IntroductionThe American Heart Association (AHA) recommends regionalized care following out-of-hospital cardiac arrest (OHCA) at cardiac resuscitation centers (CRCs). Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI) capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California.MethodsWe combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD), and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a “present on admission” diagnosis of cardiac arrest (ICD-9-CM code 427.5). We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a “present on admission” diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented.ResultsOf the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4–13%) met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24–26%) of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34–52%) admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47–65%) responded to the survey; 69/70 (99%, 95% CI 92–100%) reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI 4.7–5.7%) received therapeutic hypothermia and 18% (1372/7780; 95% CI 17–19%) underwent cardiac catheterization.ConclusionApproximately 10% of hospitals met key criteria for AHA level 1 CRCs. These hospitals treated one-quarter of patients resuscitated from OHCA in 2011. The feasibility of regionalized care for OHCA requires detailed evaluation prior to widespread implementation.
Highlights
The American Heart Association (AHA) recommends regionalized care following out-of-hospital cardiac arrest (OHCA) at cardiac resuscitation centers (CRCs)
Of the 125 hospitals identified as 24/7 percutaneous coronary intervention (PCI) centers by the AHA, 54 (43%, 95% confidence intervals (CI) 34-52%) admitted ≥40 patients following OHCA in 2011
Five percent of admitted OHCA patients (402/7780; 95% CI 4.7-5.7%) received therapeutic hypothermia and 18% (1372/7780; 95% CI 17-19%) underwent cardiac catheterization
Summary
The American Heart Association (AHA) recommends regionalized care following out-of-hospital cardiac arrest (OHCA) at cardiac resuscitation centers (CRCs). Out-of-hospital cardiac arrest (OHCA) occurs at a rate of 52.1 per 100,000 population and has a high mortality rate.[1] Early cardiac catheterization and therapeutic hypothermia improve outcomes among post-OHCA patients,[2,3,4,5,6,7,8,9] but both are currently underutilized.[7,9,10,11,12,13,14] To improve access to these therapies, the American Heart Association (AHA) recommends regionalized OHCA care, including level 1 and 2 cardiac resuscitation centers (CRCs).[15] Key criteria for level 1 CRCs include 24/7 percutaneous coronary intervention (PCI) capability, therapeutic hypothermia capability, and annual volume of ≥40 patients with return of spontaneous circulation following OHCA. We hypothesized that fewer than 10% of hospitals would meet key level 1 CRC criteria and that a minority of OHCA patients would be admitted to these hospitals
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