title: Impact of case volume on outcome and performance of targeted temperature management in out-of-hospital cardiac arrest survivors.
abstract: OBJECTIVE
  This study aimed to determine the effect of case volume on targeted temperature management (TTM) performance, incidence of adverse events, and neurologic outcome in comatose out-of-hospital cardiac arrest (OHCA) survivors treated with TTM.
  
  
  METHODS
  We used a Web-based, multicenter registry (Korean Hypothermia Network registry), to which 24 hospitals throughout the Republic of Korea participated to study adult (≥18 years) comatose out-of-hospital cardiac arrest patients treated with TTM between 2007 and 2012. The primary outcome was neurologic outcome at hospital discharge. The secondary outcomes were inhospital mortality, TTM performance, and adverse events. We extracted propensity-matched cohorts to control for bias. Multivariate logistic regression analysis was performed to assess independent risk factors for neurologic outcome.
  
  
  RESULTS
  A total of 901 patients were included in this study; 544 (60.4%) survived to hospital discharge, and 248 (27.5%) were discharged with good neurologic outcome. The high-volume hospitals initiated TTM significantly earlier and had lower rates of hyperglycemia, bleeding, hypotension, and rebound hyperthermia. However, neurologic outcome and inhospital mortality were comparable between high-volume (27.7% and 44.6%, respectively) and low-volume hospitals (21.1% and 40.5%) in the propensity-matched cohorts. The adjusted odds ratio for the high-volume hospitals compared with low-volume hospitals was 1.506 (95% confidence interval, 0.875-2.592) for poor neurologic outcome.
  
  
  CONCLUSIONS
  Higher TTM case volume was significantly associated with early initiation of TTM and lower incidence of adverse events. However, case volume had no association with neurologic outcome and inhospital mortality.
authors.affiliation: Department of Emergency Medicine, Myongji Hospital, Goyang, Gyeonggi-do, Republic of Korea.
authors.forename: Seung Joon
authors.initials: SJ
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Kyung Woon
authors.initials: KW
authors.lastname: Jeung
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. Electronic address: bbukkuk@hanmail.net.
authors.forename: Byung Kook
authors.initials: BK
authors.lastname: Lee
authors.affiliation: Department of Emergency Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea.
authors.forename: Yong Il
authors.initials: YI
authors.lastname: Min
authors.affiliation: Department of Emergency Medicine, School of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Kyu Nam
authors.initials: KN
authors.lastname: Park
authors.affiliation: Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Gil Joon
authors.initials: GJ
authors.lastname: Suh
authors.affiliation: Department of Emergency Medicine, College of Medicine, Seoul National University, Seoul, Republic of Korea.
authors.forename: Kyung Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Emergency Medicine, Kangnam Sacred Heart Hospital, Hallym University, Seoul, Republic of Korea.
authors.forename: Gu Hyun
authors.initials: GH
authors.lastname: Kang
mesh_terms: D000328:Adult; D000368:Aged; D001833:Body Temperature Regulation; D003128:Coma / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007036:Hypothermia, Induced; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D057216:Propensity Score; D012042:Registries; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors; D016526:Workload