Regionalization of post-cardiac arrest care: implementation of a cardiac resuscitation center.
BACKGROUND
Guidelines recommend standardized treatment of post-cardiac arrest patients to improve outcomes. However, the infrastructure, resources, and personnel required to meet the complex needs of cardiac arrest victims remain a barrier to care. Given that regionalization of time-dependent high-acuity illness is an emerging paradigm, the aim of the present study was to develop and implement a regionalized approach to post-cardiac arrest care.


METHODS
We performed a prospective observational study on all patients treated in a regionalized clinical pathway from November 2007 through June 2011. All patients were enrolled after admission to an urban academic medical center. Clinical data including arrest and treatment variables, complications, and outcome were collected on consecutive patients with the use of a preformatted standard data collection tool using Utstein criteria.


RESULTS
A total of 220 patients were enrolled; 127 (58%) patients were local direct admissions from our community, and 93 (42%) were transferred from 1 of 24 outlying referral hospitals. One hundred six (48%, 95% CI 38%-53%) patients survived to hospital discharge. The primary outcome of hospital survival with good neurologic function was observed in 94 (43%, 95% CI 32%-48%). There was no difference in survival with good neurologic outcome among local and referred patients. Overall 1-year survival was 44% (95% CI 38%-51%). Among patients discharged from the hospital with good neurologic function, 93% (95% CI 85%-97%) remained alive at 1 year.


CONCLUSIONS
Development of a regionalized approach to post-cardiac arrest care using previously established referral relationships is feasible, and implementation of such an approach was clinically effective in our region.
Department of Internal Medicine, PO Box 32861, Carolinas Medical Center, Charlotte, NC 28232–2861, USA. Alan.heffner@carolinashealthcare.org
Alan C
AC
Heffner
David A
DA
Pearson
Marcy L
ML
Nussbaum
Alan E
AE
Jones
D002300:Cardiac Care Facilities / Q000458:organization & administration / Q000706:statistics & numerical data; D016887:Cardiopulmonary Resuscitation / Q000401:mortality; D005260:Female; D006323:Heart Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D010360:Patient Transfer / Q000706:statistics & numerical data; D011446:Prospective Studies; D016019:Survival Analysis; D013610:Tachycardia / Q000150:complications; D016896:Treatment Outcome; D014693:Ventricular Fibrillation / Q000150:complications