Hospital characteristics improve survival of OHCA patients
MedWire News: Certain hospital characteristics are associated with improved survival rates in out-of-hospital cardiac arrest (OHCA) patients, Australian researchers suggest.
Dion Stub (Alfred Hospital, Melbourne) and colleagues found increased survival in patients transported to cardiac centers in Australia that provide 24-hour interventional cardiac services during working hours (0800-1700 hours), compared with patients transported to non-cardiac centers and admitted outside working hours.
"Perhaps surprisingly, however, this study also found that hospital size (numbers of beds) and OCHA patient throughput did not influence outcome," write the authors in the journal Heart.
Stub et al found that between January 2003 and March 2010, Australian paramedics attempted resuscitation in 9971 patients with OHCA of suspected cardiac etiology.
In all, 29% of patients were transported to hospital with return of spontaneous circulation (ROSC). Of these, 63% were treated at cardiac centers, which provide emergency cardiac catheterization facilities for patients with acute coronary syndromes including OCHA, 24 hours a day, 7 days a week.
After adjusting for age, initial rhythm, witnessed cardiac arrest, and time until return of circulation, multivariate analysis revealed that patients treated at a cardiac center were 40% more likely to survive to hospital discharge than patients transported to centers where cardiac services were not provided (p=0.003). Patients who were admitted during working hours had a 34% increased chance of survival to hospital discharge than patients admitted outside these hours (p=0.004).
OHCA patient volume and total hospital bed number were not independently associated with outcome.
The highest rate of survival to discharge was seen at major trauma-level cardiac centers, where the conditional probability of survival was 42.1%, compared with 29.0% at non-cardiac centers (p<0.001).
"Further research into the individual components of post-resuscitative care is required to determine those factors within hospitals that improve outcomes," the authors conclude.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Piriya Mahendra