Choice of hospital after out-of-hospital cardiac arrest - a decision with far reaching consequences - a study in a large German city
IntroductionBetween 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have been able to show that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA.
This data may only be partially transferable to the German medical system where responders are in-field emergency medical physicians.The present study determines the influence of the emergency physician's choice of admitting hospital on patient outcome after OHCA in a large urban setting.
All data for patients collected in the German Resuscitation Registry for the city of Dortmund during 2007 and 2008 were analyzed. Patients under 18 years of age, with traumatic mechanism, and with incomplete charts were excluded.
Admitting hospitals were divided into two groups: 1 - those without the capability for percutaneous coronary intervention (PCI) and 2- those with PCI capability. Data were analyzed by multi-variate statistics, taking into account the effects of mild therapeutic hypothermia treatment and PCI capability of the admitting hospital with respect to the neurological status upon hospital discharge.
Between 2007 and 2008, 1,109 CPR attempts were registered for the city of Dortmund, of which 889 could be included in our study.
Return of spontaneous circulation (ROSC) was achieved in 360 of 889 patients (40.5%). 282 of 889 patients displayed ROSC during transport to the hospital (31.7%); 152 were transported with ongoing CPR (17.1%).
Of the total 434 patients admitted to hospital, 264 were admitted to hospitals without PCI capability and 170 to hospitals with PCI capability. Multivariate analysis demonstrated a significant influence on patient discharge with good neurological status for those admitted to PCI-hospitals (OR 3.14 (1.51-6.56)), independently of receiving mild therapeutic hypothermia and/or PCI.
Compared to patients admitted to hospitals without PCI capability, significantly more patients in PCI-hospitals were discharged alive (41% vs. 13%; p<0.001) and remained alive one year after the event (28% vs.
Choice of admitting hospital for patients suffering OHCA significantly influences treatment and outcome. This influence is independent of PCI performance as well as independent of mild therapeutic hypothermia.
Further analysis is required to determine the possible parameters determining patient outcome.
Author: Jan WnentStephan SeewaldMatthias HeringlakeHans LemkeKirk BrauerRolf LeferingMatthias FischerTanja JantzenBerthold BeinMartin MesselkenJan-Thorsten Grasner Credits/Source: Critical Care 2012, 16:R164
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