title: Choice of hospital after out-of-hospital cardiac arrest--a decision with far-reaching consequences: a study in a large German city.
abstract: BACKGROUND
  Between 1 and 31% of patients suffering out-of-hospital cardiac arrest (OHCA) survive to discharge from hospital. International studies have shown that the level of care provided by the admitting hospital determines survival for patients suffering from OHCA. These 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.
  
  
  METHODS
  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: those without the capability for percutaneous coronary intervention (PCI), and those with PCI capability. Data were analyzed by multivariate 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.
  
  
  RESULTS
  Between 2007 and 2008 a total of 1,109 cardiopulmonary resuscitation attempts were registered for the city of Dortmund, of which 889 could be included in our study. Return of spontaneous circulation was achieved in 360 of 889 patients (40.5%). In total, 282 of 889 patients displayed return of spontaneous circulation during transport to the hospital (31.7%); 152 were transported with ongoing cardiopulmonary resuscitation (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 (odds ratio 3.14 (95% confidence interval 1.51 to 6.56)), independent of receiving mild therapeutic hypothermia and/or PCI. Compared with 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 1 year after the event (28% vs. 6%, P < 0.001).
  
  
  CONCLUSIONS
  The choice of admitting hospital for patients suffering OHCA significantly influences treatment and outcome. This influence is independent of PCI performance and of mild therapeutic hypothermia. Further analysis is required to determine the possible parameters determining patient outcome.
authors.forename: Jan
authors.initials: J
authors.lastname: Wnent
authors.forename: Stephan
authors.initials: S
authors.lastname: Seewald
authors.forename: Matthias
authors.initials: M
authors.lastname: Heringlake
authors.forename: Hans
authors.initials: H
authors.lastname: Lemke
authors.forename: Kirk
authors.initials: K
authors.lastname: Brauer
authors.forename: Rolf
authors.initials: R
authors.lastname: Lefering
authors.forename: Matthias
authors.initials: M
authors.lastname: Fischer
authors.forename: Tanja
authors.initials: T
authors.lastname: Jantzen
authors.forename: Berthold
authors.initials: B
authors.lastname: Bein
authors.forename: Martin
authors.initials: M
authors.lastname: Messelken
authors.forename: Jan-Thorsten
authors.initials: JT
authors.lastname: Gräsner
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000592:standards / Q000639:trends*; D002755:Choice Behavior; D004632:Emergency Medical Services / Q000592:standards / Q000639:trends*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D010343:Patient Admission / Q000592:standards / Q000639:trends*; D062645:Percutaneous Coronary Intervention / Q000592:standards / Q000639:trends