Author(s): Carr BG, Kahn JM, Merchant RM, Kramer AA, Neumar RW
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Abstract AIM: A growing body of evidence suggests that variability in post-cardiac arrest care contributes to differential outcomes of patients with initial return of spontaneous circulation after cardiac arrest. We examined hospital-level variation in mortality of patients admitted to United States intensive care units (ICUs) with a diagnosis of cardiac arrest. METHODS: Patients with a primary ICU admission diagnosis of cardiac arrest were identified in the 2002--2005 Acute Physiology and Chronic Health Evaluation (APACHE) IV dataset, a multicenter clinical registry of ICU patients. RESULTS: We identified 4674 patients from 39 hospitals. The median number of annual patients was 33 per hospital (range: 12-116). Mean APACHE score was 94 (+/-38), and overall mortality was 56.8\%. Age, severity of illness (acute physiology score), and admission Glasgow Coma Scale were all associated with increased mortality (p<0.001). There was no survival difference for patients admitted from the emergency department vs. the inpatient floor. Among institutions, unadjusted in-hospital mortality ranged from 41\% to 81\%. After adjusting for age and severity of illness, institutional mortality ranged from 46\% to 68\%. Patients treated at higher volume centers were significantly less likely to die in the hospital. CONCLUSIONS: We demonstrate hospital-level variation in severity adjusted mortality among patients admitted to the ICU after cardiac arrest. We identify a volume-outcome relationship showing lower mortality among patients admitted to ICUs that treat a high volume of post-cardiac arrest patients. Prospective studies should identify hospital-level and patient care factors that contribute to post-cardiac arrest survival.
This article was published in Resuscitation
and referenced in Emergency Medicine: Open Access