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Variability in functional outcome and treatment practices by treatment center after out-of-hospital cardiac arrest: analysis of International Cardiac Arrest Registry
TL. May, CW. Lary, RR. Riker, H. Friberg, N. Patel, E. Søreide, JA. McPherson, J. Undén, R. Hand, K. Sunde, P. Stammet, S. Rubertsson, J. Belohlvaek, A. Dupont, KG. Hirsch, F. Valsson, K. Kern, F. Sadaka, J. Israelsson, J. Dankiewicz, N. Nielsen,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu časopisecké články
Grantová podpora
KL2 TR001063
NCATS NIH HHS - United States
U54 GM115516
NIGMS NIH HHS - United States
KL2TR001063
NCATS NIH HHS - United States
NLK
ProQuest Central
od 1997-01-01 do Před 1 rokem
Medline Complete (EBSCOhost)
od 2000-01-01 do Před 1 rokem
Nursing & Allied Health Database (ProQuest)
od 1997-01-01 do Před 1 rokem
Health & Medicine (ProQuest)
od 1997-01-01 do Před 1 rokem
- MeSH
- internacionalita MeSH
- lidé středního věku MeSH
- lidé MeSH
- registrace statistika a číselné údaje MeSH
- senioři MeSH
- výsledek terapie * MeSH
- zástava srdce mimo nemocnici epidemiologie terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE: Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. METHODS: Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. RESULTS: A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. CONCLUSIONS: Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
Center for Outcomes Research Maine Medical Center Portland ME USA
Department of Anesthesia and Intensive Care Landspitali University Hospital Reykyavik Iceland
Department of Anesthesia and Intensive Care Skåne University Hospital Lund University Lund Sweden
Department of Cardiology Northeast Georgia Medical Center Gainesville Georgia USA
Department of Critical Care Eastern Maine Medical Center Bangor ME USA
Department of Critical Care Services Maine Medical Center 22 Bramhall St Portland ME 04102 USA
Department of Internal Medicine Division of Cardiology Kalmar County Hospital Kalmar Sweden
Department of Neurology Columbia Presbyterian Medical Center New York NY USA
Department of Surgical Sciences Anesthesiology and Intensive Care Uppsala University Uppsala Sweden
Division of Cardiology Sarver Heart Center University of Arizona Tucson USA
Division of Cardiovascular Medicine Lehigh Valley Hospital and Health Network Allentown PA USA
Division of Cardiovascular Medicine Vanderbilt University Medical Center Nashville TN USA
Medical Department National Rescue Services Luxembourg 14 rue Stümper 2557 Luxembourg Luxembourg
Citace poskytuje Crossref.org
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- $a May, Teresa L $u Department of Critical Care Services, Maine Medical Center, 22 Bramhall St, Portland, ME, 04102, USA. tmay@mmc.org. Clinical and Translational Science Institute, Tufts University, Boston, ME, 02111, USA. tmay@mmc.org.
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- $a PURPOSE: Functional outcomes vary between centers after out-of-hospital cardiac arrest (OHCA) and are partially explained by pre-existing health status and arrest characteristics, while the effects of in-hospital treatments on functional outcome are less understood. We examined variation in functional outcomes by center after adjusting for patient- and arrest-specific characteristics and evaluated how in-hospital management differs between high- and low-performing centers. METHODS: Analysis of observational registry data within the International Cardiac Arrest Registry was used to perform a hierarchical model of center-specific risk standardized rates for good outcome, adjusted for demographics, pre-existing functional status, and arrest-related factors with treatment center as a random effect variable. We described the variability in treatments and diagnostic tests that may influence outcome at centers with adjusted rates significantly above and below registry average. RESULTS: A total of 3855 patients were admitted to an ICU following cardiac arrest with return of spontaneous circulation. The overall prevalence of good outcome was 11-63% among centers. After adjustment, center-specific risk standardized rates for good functional outcome ranged from 0.47 (0.37-0.58) to 0.20 (0.12-0.26). High-performing centers had faster time to goal temperature, were more likely to have goal temperature of 33 °C, more likely to perform unconscious cardiac catheterization and percutaneous coronary intervention, and had differing prognostication practices than low-performing centers. CONCLUSIONS: Center-specific differences in outcomes after OHCA after adjusting for patient-specific factors exist. This variation could partially be explained by in-hospital management differences. Future research should address the contribution of these factors to the differences in outcomes after resuscitation.
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