Abstract
BackgroundSurvival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care.MethodsA prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres.ResultsAfter excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001).ConclusionIn the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.
Highlights
Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates
Data were collected on patient demographics and clinical characteristics related to cardiac arrest and post-cardiopulmonary resuscitation (CPR) treatment, according to Utstein and COSCA
Compared to other hospitals in the Netherlands, the hospitals included in this study were more often trauma centres (66.7% vs. 26.3%), offered thoracic surgery (41.7% vs. 17.2%), and were more often able to facilitate extracorporeal membrane oxygenation (ECMO) life support (50.0% vs. 14.3%, see Table 1)
Summary
Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. Notable examples of hospital-level structure of care factors relevant to IHCA are availability of advanced life-support (ALS) trained personnel, cardiopulmonary resuscitation (CPR) training frequency of personnel, assigned roles of specialists in the cardiopulmonary resuscitation team, and the availability of an intensive care physician. These particular structural indicators have been shown to vary substantially between Dutch hospitals [8]. Outcome metrics such as mortality and cerebral performance category (CPC) score at discharge are relevant patient-level quality indicators [11]
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