Interhospital variability in Out-of-Hospital cardiac arrest survival in a large metropolitan area.
Interhospital variability in Out-of-Hospital cardiac arrest survival in a large metropolitan area.
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大都市区院外心脏骤停存活率的院内变异性。
DOI：
10.1016/j.resplu.2023.100385
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发表时间：
2023
影响因子：
2.4
通讯作者：
DelRios,Marina
中科院分区：
文献类型：
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作者：
Kotini-Shah,Pavitra;Blum,Nicole;Khosla,Shaveta;Weber,Joseph;Markul,Eddie;Tataris,Katie;Campbell,Teri;VandenHoek,Terry;DelRios,Marina
背景美国各地院外心脏骤停（OHCA）的生存率差异很大。医院OHCA容量和ST段抬高型心肌梗死（STEMI）接收中心（SRC）指定对survival.MethodsThis的影响尚未完全了解是一项回顾性分析成人OHCA谁存活到入院报告芝加哥心脏骤停登记提高生存率（CARES）数据库从2013年5月1日至2019年12月31日。分层逻辑回归模型的产生和调整医院的特点。在调整了心脏骤停特征后，计算了每家医院的出院生存率（SHD）和脑功能分类（CPC）1-2。根据总的心脏停搏量将医院分为四分位数（Q1-Q4），以比较四分位数之间的SHD和CPC 1-2。本研究纳入的33家芝加哥医院中有21家被指定为SRC。按医院列出的调整后SHD和CPC 1-2发生率范围分别为27.3%-37.0%和8.9%-25.1%。SRC认定对SHD（OR 0.96; 95% CI，0.71-1.30）和CPC 1-2（OR 1.17; 95% CI，0.74-1.84）均无显著影响。OHCA体积四分位数对SHD无显著影响（Q2：OR 0.94; 95% CI，0.54-1.60; Q3：OR 1.30; 95% CI，0.78-2.16; Q4：OR 1.25; 95% CI，0.74-2.10）无CPC 1-2（Q2：OR0.75; 95%CI，0.36-1.54; Q3：OR0.94; 95%CI，0.48-1.87; Q4：OR0.97; 95%CI，0.48-1.97）。结论SHD和CPC 1-2的院内变异性不能用院内停搏量或SRC状态来解释。进一步的研究是必要的，以探讨医院间的差异性的原因。
BackgroundOut-of-hospital cardiac arrest (OHCA) survival varies widely across the United States. The impact of hospital OHCA volume and ST-elevation myocardial infarction (STEMI) Receiving Center (SRC) designation on survival is not fully understood.MethodsThis was a retrospective analysis of adult OHCA who survived to hospital admission reported to the Chicago Cardiac Arrest Registry to Enhance Survival (CARES) database from May 1, 2013 to December 31, 2019. Hierarchical logistic regression models were generated and adjusted by hospital characteristics. Survival to hospital discharge (SHD) and cerebral performance category (CPC) 1–2 at each hospital were calculated after adjusting for arrest characteristics. Hospitals were assigned quartiles (Q1-Q4) based on total arrest volume to allow for comparison of SHD and CPC 1–2 between quartiles.Results4,020 patients met inclusion criteria. 21 of the 33 Chicago hospitals included in this study were designated SRCs. Adjusted SHD and CPC 1–2 rates ranged from 27.3% to 37.0% and from 8.9% to 25.1%, respectively, by hospital. SRC designation did not significantly affect SHD (OR 0.96; 95% CI, 0.71–1.30) nor CPC 1–2 (OR 1.17; 95% CI, 0.74–1.84). OHCA volume quartiles did not significantly affect SHD (Q2: OR 0.94; 95% CI, 0.54–1.60; Q3: OR 1.30; 95% CI, 0.78–2.16; Q4: OR 1.25; 95% CI, 0.74–2.10) nor CPC 1–2 (Q2: OR 0.75; 95% CI, 0.36–1.54; Q3: OR 0.94; 95% CI, 0.48–1.87; Q4: OR 0.97; 95% CI, 0.48–1.97).ConclusionInterhospital variability in both SHD and CPC 1–2 cannot be explained by hospital arrest volume nor SRC status. Further research is warranted to explore reasons for interhospital variability.