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

B. Y. Gravesteijn*, M. Schluep, the ROUTINE-study consortium, H. F. Lingsma, R. J. Stolker, H. Endeman, S. E. Hoeks

*Corresponding author for this work

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Abstract

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.

Original languageEnglish
Article number329
JournalCritical Care
Volume25
Issue number1
DOIs
Publication statusPublished - 10 Sept 2021

Bibliographical note

Funding Information:
The study was funded by departmental funds and supported by a small contribution from an unrestricted grant from the European Society of Anaesthesiology (ESA) and AirLLiquide (€250). These funds have been used to give out giftcards (€25) as a reward for ten respondents. Both ESA and Air Liquide did not have any role in the design or analysis of this study.

Funding Information:
We are grateful for Virginia E. Tangel (Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, the Netherlands, and Department of Anesthesiology, Weill Cornell Medicine, New York, NY, United States) for her revisions of the final manuscript. ROUTiNE study consortium : Evert-Jan Wils, Cees Kuijs, Michiel Blans, Bas van den Bogaard, Ankie Koopman ? van Gemert, Chris Hukshorn, Nardo van der Meer, Marco Knook, Trudy van Melsen, Ren? Peters, Patrick Perik, Jan Assink, Gerben Spijkers and Wytze Vermeijden.

Publisher Copyright:
© 2021, The Author(s).

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