Abstract
IntroductionThe study aimed to determine the impact of treatment frequency, hospital size, and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units.MethodsProspectively recorded data from 242,588 adults consecutively admitted to 87 Austrian intensive care units over a period of 13 years (1998 to 2010) were analyzed retrospectively. Multivariate analysis was used to assess the effect of the frequency of postresuscitation care on mortality, correcting for baseline parameters, severity of illness, hospital size, and capability to perform coronary angiography and intervention.ResultsIn total, 5,857 patients had had cardiac arrest and were admitted to an intensive care unit. Observed hospital mortality was 56% in the cardiac-arrest cohort (3,302 nonsurvivors). Patients treated in intensive care units with a high frequency of postresuscitation care generally had high severity of illness (median Simplified Acute Physiology Score (SAPS II), 65). Intensive care units with a higher frequency of care showed improved risk-adjusted mortality. The SAPS II adjusted, observed-to-expected mortality ratios (O/E-Ratios) in the three strata (<18; 18 to 26; >26 resuscitations per ICU per year) were 0.869 (95% confidence interval, 0.844 to 894), 0.876 (0.850 to 0.902), and 0.808 (0.784 to 0.833).ConclusionsIn this database analysis, a high frequency of post-cardiac arrest care at an intensive care unit seemed to be associated with improved outcome of cardiac-arrest patients. We were able to identify patients who seemed to profit more from high frequency of care, namely, those with an intermediate severity of illness. Considering these findings, cardiac-arrest care centers might be a reasonable step to improve outcome in this specific population of cardiac-arrest patients.
Highlights
The study aimed to determine the impact of treatment frequency, hospital size, and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units
The collected data included demographic background information, such as age, sex, and preexisting chronic conditions; the reasons for intensive care unit (ICU) admission that were recorded according to a list of medical and surgical diagnoses [25]; severity of illness according to the Simplified Acute Physiologic Score (SAPS II), determined at admission; level of provided care, as measured by the Simplified Therapeutic Intervention Scoring System (TISS-28) [26]; length of ICU and hospital stay; and status at ICU and hospital discharge
We evaluated the association between patient-related factors, comorbidities, intensive care measures, and their impact on the outcome for patients treated after cardiac arrest in different ICUs
Summary
The study aimed to determine the impact of treatment frequency, hospital size, and capability on mortality of patients admitted after cardiac arrest for postresuscitation care to different intensive care units. Cardiac arrest occurs in 375,000 adults in Europe every year. Several factors (patient related and resuscitation related) have been identified to have considerable impact on outcome. Cardiopulmonary resuscitation of good quality, with uninterrupted chest compressions as well as early defibrillation (depending on initial electrocardiogram rhythm) significantly improves the outcome after cardiac arrest [5,6,7]. The etiology of cardiac arrest is known to influence the prognosis. Of note is the fact that the outcome of patients resuscitated from cardiac arrest
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