Journal
RESUSCITATION
Volume 92, Issue -, Pages 45-52Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.resuscitation.2015.04.015
Keywords
Cardiac arrest; Resuscitation; Performance score; Post resuscitation care
Categories
Funding
- NHMRC/NHF early career fellowship [1090302/100516]
- University of Washington via the Leonard A Cobb Medic One Foundation Endowed Chair in Prehospital Emergency Care
- National Heart Lung Blood Institute, Bethesda, MD. Resuscitation Outcomes Consortium [U01 HL077863-05]
- Co-PI
- Food and Drug Administration, Silver Spring, MD
- Cardiac Science Corp, Waukesha, WI
- Heartsine Technologies Inc., Newtown, PA
- Philips Healthcare Inc., Bothell, WA
- Physio-Control Inc., Redmond, WA
- ZOLL Inc., Chelmsford, MA. University of Washington Dynamic AED Registry
- Velomedix Inc., Menlo Park, CA
- NHLBI
- NINDS
- Eli Lilly
- Janssen
- NIH
- Laerdal Foundation
- Zoll Foundation
- National Heart, Lung and Blood Institute [5U01 HL077863, HL077866, HL077867, HL077871, HL077872, HL077873, HL077881, HL077885, HL077887, HL077908]
- National Institute of Neurological Disorders and Stroke, U.S. Army Medical Research & Material Command
- Canadian Institutes of Health Research (CIHR) - Institute of Circulatory and Respiratory Health, Defence Research and Development Canada
- Heart, Stroke Foundation of Canada
- American Heart Association
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Background: Survival varies among those resuscitated from out-of-hospital cardiac arrest (OHCA). Evidence-based performance measures have been used to describe hospital quality of care in conditions such as acute coronary syndrome and major trauma. It remains unclear if adherence to performance measures is associated with better outcome in patients hospitalized after OHCA. Objectives: To assess whether a composite performance score based on evidence-based guidelines for care of patients resuscitated from OHCA was independently associated with clinical outcomes. Methods: Included were 3252 patients with OHCA who received care at 111 U.S. and Canadian hospitals participating in the Resuscitation Outcomes Consortium (ROC-PRIMED) study between June 2007 and October 2009. We calculated composite performance scores for all patients, aggregated these at the hospital level, then associated them with patient mortality and favorable neurological status at discharge. Results: Composite performance scores varied widely (median [IQR] scores from lowest to highest hospital quartiles, 21% [20%, 25%] vs. 59% [55%, 64%]. Adjusted survival to discharge increased with each quartile of performance score (from lowest to highest: 16.2%, 20.8%, 28.5%, 34.8%, P < 0.01), with similar findings for adjusted rates of good neurologic status. Hospital score was significantly associated with outcome after risk adjustment for established baseline factors (highest vs. lowest adherence quartile: adjusted OR of survival 1.64; 95% CI 1.13, 2.38). Conclusions: Greater survival and favorable neurologic status at discharge were associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Consideration should be given to measuring, reporting and improving hospital adherence to guideline-based performance measures, which could improve outcomes following OHCA. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
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