Efect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest

Efect of annual hospital admissions of out-of-hospital cardiac arrest patients on prognosis following cardiac arrest

Cardiopulmonary resuscitation, Hospital volume, Neurological outcome, Out-of-hospital cardiac arrest,
Prediction, Prognosis

Background: Although the prognosis of patients treated at specialized facilities has improved, the relationship
between the number of patients treated at hospitals and prognosis is controversial and lacks constancy in those with
out-of-hospital cardiac arrest (OHCA). This study aimed to clarify the efect of annual hospital admissions on the prognosis of adult patients with OHCA by analyzing a large cohort.
Methods: The efect of annual hospital admissions on patient prognosis was analyzed retrospectively using data
from the Japanese Association for Acute Medicine OHCA registry, a nationwide multihospital prospective database.
This study analyzed 3632 of 35,754 patients hospitalized for OHCA of cardiac origin at 86 hospitals. The hospitals
were divided into tertiles based on the volume of annual admissions. The efect of hospital volume on prognosis
was analyzed using logistic regression analysis with multiple imputation. Furthermore, three subgroup analyses were
performed for patients with return of spontaneous circulation (ROSC) before arrival at the emergency department,
patients admitted to critical care medical centers, and patients admitted to extracorporeal membrane oxygenationcapable hospitals.
Results: Favorable neurological outcomes 30days after OHCA for patients overall showed no advantage for mediumand high-volume centers over low-volume centers; Odds ratio (OR) 0.989, (95% Confdence interval [CI] 0.562-1.741),
OR 1.504 (95% CI 0.919-2.463), respectively. However, the frequency of favorable neurological outcomes in OHCA
patients with ROSC before arrival at the emergency department at high-volume centers was higher than those at
low-volume centers (OR 1.955, 95% CI 1.033-3.851).
Conclusion: Hospital volume did not signifcantly afect the prognosis of adult patients with OHCA. However, transport to a high-volume hospital may improve the neurological prognosis in OHCA patients with ROSC before arrival at
the emergency department.

Takumi Tsuchida, Kota Ono, Kunihiko Maekawa, Mariko Hayamizu and Mineji Hayakawa

BMC Emergency Medicine

(2022) 22:121

Fajar Bagus W

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