title: Availability and utilization of cardiac resuscitation centers.
abstract: BACKGROUND
  The American Heart Association (AHA) recommends regionalized care following out-of-hospital cardiac arrest (OHCA) at cardiac resuscitation centers (CRCs). Key level 1 CRC criteria include 24/7 percutaneous coronary intervention (PCI) capability, therapeutic hypothermia capability, and annual volume of ≥40 patients resuscitated from OHCA. Our objective was to characterize the availability and utilization of resources relevant to post-cardiac arrest care, including level 1 CRCs in California.
  
  
  METHODS
  We combined data from the AHA, the California Office of Statewide Health Planning and Development (OSHPD), and surveys to identify CRCs. We surveyed emergency department directors and nurse managers at all 24/7 PCI centers identified by the AHA to determine their post-OHCA care capabilities. The survey included questions regarding therapeutic hypothermia use and specialist availability and was pilot-tested prior to distribution. Cases of OHCA were identified in the 2011 OSHPD Patient Discharge Database using a "present on admission" diagnosis of cardiac arrest (ICD-9-CM code 427.5). We defined key level 1 CRC criteria as 24/7 PCI capability, therapeutic hypothermia, and annual volume ≥40 patients admitted with a "present on admission" diagnosis of cardiac arrest. Our primary outcome was the proportion of hospitals meeting these criteria. Descriptive statistics and 95% CI are presented.
  
  
  RESULTS
  Of the 333 acute care hospitals in California, 31 (9.3%, 95% CI 6.4-13%) met level 1 CRC criteria. These hospitals treated 25% (1937/7780; 95% CI 24-26%) of all admitted OHCA patients in California in 2011. Of the 125 hospitals identified as 24/7 PCI centers by the AHA, 54 (43%, 95% CI 34-52%) admitted ≥40 patients following OHCA in 2011. Seventy (56%, 95% CI 47-65%) responded to the survey; 69/70 (99%, 95% CI 92-100%) reported having a therapeutic hypothermia protocol in effect by 2011. Five percent of admitted OHCA patients (402/7780; 95% CI 4.7-5.7%) received therapeutic hypothermia and 18% (1372/7780; 95% CI 17-19%) underwent cardiac catheterization.
  
  
  CONCLUSIONS
  Approximately 10% of hospitals met key criteria for AHA level 1 CRCs. These hospitals treated one-quarter of patients resuscitated from OHCA in 2011. The feasibility of regionalized care for OHCA requires detailed evaluation prior to widespread implementation.
authors.affiliation: University of California Davis, Department of Emergency Medicine, Sacramento, California.
authors.forename: Bryn E
authors.initials: BE
authors.lastname: Mumma
authors.affiliation: University of California Davis, Department of Emergency Medicine, Sacramento, California.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: University of California Davis, Department of Emergency Medicine, Sacramento, California.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D002140:California / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D002985:Clinical Protocols; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D006302:Health Services Research; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007036:Hypothermia, Induced / Q000706:statistics & numerical data*; D058687:Out-of-Hospital Cardiac Arrest / Q000453:epidemiology / Q000628:therapy*; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology