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Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study

BACKGROUND: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity i...

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Autores principales: Gravesteijn, B. Y., Schluep, M., Lingsma, H. F., Stolker, R. J., Endeman, H., Hoeks, S. E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431928/
https://www.ncbi.nlm.nih.gov/pubmed/34507601
http://dx.doi.org/10.1186/s13054-021-03754-8
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author Gravesteijn, B. Y.
Schluep, M.
Lingsma, H. F.
Stolker, R. J.
Endeman, H.
Hoeks, S. E.
author_facet Gravesteijn, B. Y.
Schluep, M.
Lingsma, H. F.
Stolker, R. J.
Endeman, H.
Hoeks, S. E.
author_sort Gravesteijn, B. Y.
collection PubMed
description BACKGROUND: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03754-8.
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spelling pubmed-84319282021-09-10 Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study Gravesteijn, B. Y. Schluep, M. Lingsma, H. F. Stolker, R. J. Endeman, H. Hoeks, S. E. Crit Care Research BACKGROUND: Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care. METHODS: A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres. RESULTS: After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001). CONCLUSION: In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03754-8. BioMed Central 2021-09-10 /pmc/articles/PMC8431928/ /pubmed/34507601 http://dx.doi.org/10.1186/s13054-021-03754-8 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Gravesteijn, B. Y.
Schluep, M.
Lingsma, H. F.
Stolker, R. J.
Endeman, H.
Hoeks, S. E.
Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title_full Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title_fullStr Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title_full_unstemmed Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title_short Between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
title_sort between-centre differences in care for in-hospital cardiac arrest: a prospective cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8431928/
https://www.ncbi.nlm.nih.gov/pubmed/34507601
http://dx.doi.org/10.1186/s13054-021-03754-8
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