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Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry.

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Authors
May, Teresa L
Lary, Christine W
Riker, Richard R
Friberg, Hans
Patel, Nainesh
Søreide, Eldar
McPherson, John A
Undén, Johan
Hand, Robert
Sunde, Kjetil
Stammet, Pascal
Rubertsson, Stein
Belohlvaek, Jan
Dupont, Allison
Hirsch, Karen G
Valsson, Felix
Kern, Karl
Sadaka, Farid
Israelsson, Johan
Dankiewicz, Josef
Nielsen, Niklas
Seder, David B
Agarwal, Sachin
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Issue Date
2019-05-01

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Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry. 2019, 45(5):637-646 Intensive Care Med
Abstract
Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
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https://link.springer.com/article/10.1007/s00134-019-05580-7
ae974a485f413a2113503eed53cd6c53
10.1007/s00134-019-05580-7
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English Journal Articles (Peer Reviewed)

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