title: Quality of post arrest care does not differ by time of day at a specialized resuscitation center.
abstract: Previous studies suggest worse outcomes after out-of-hospital cardiac arrest (OHCA) at night. We analyzed whether patients admitted after nontraumatic OHCA to a resuscitation center received the same quality post arrest care at day and night and whether quality of care affected clinical outcomes. We analyzed data of OHCA patients with return of spontaneous circulation admitted to the Vienna general hospital emergency department between January 2006 and May 2013. Data reported include admission time (day defined from 8 AM to 4 PM based on staffing), time to initiation of hypothermia, and door-to-balloon time in patients with ST-elevation myocardial infarction. Survival and cognitive performance at 12 months were assessed. In this retrospective observational study, 1059 patients (74% males, n = 784) with a mean age of 58 ± 16 years were analyzed. The vast majority was treated with induced hypothermia (77% of day vs. 79% of night admissions, P = 0.32) within 1 hour of admission (median time admission to cooling 27 (confidence interval [CI]: 10-60) vs. 23 (CI: 11-59) minutes day vs. night, P = 0.99). In 298 patients with ST-elevation myocardial infarction, median door-to-balloon time did not differ between day and night admissions (82 minutes, CI: 60 to 142 for day vs. 86 minutes, CI: 50 to 135 for night, P = 0.36). At 12 months, survival was recorded in 238 of 490 day and 275 of 569 night admissions (49% vs. 48%, P = 0.94%), and a good neurologic outcome was recorded in 210 of 490 day and 231 of 569 night admissions (43% vs. 41%, P = 0.46). Patients admitted to our department after OHCA were equally likely to receive timely high-quality postresuscitation care irrespective of time of day. Survival and good neurologic outcome at 12 months did not differ between day and night admissions. Our results may support the concept of specialized post arrest care centers.
authors: From the Department of Emergency Medicine (TU, FS, CW, WS, Alexander Spiel, Andreas Schober, PS), Medical University of Vienna, Vienna, Austria; and CRISMA Center (FBM), Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
authors: Thomas
authors: T
authors: Uray
authors: Fritz
authors: F
authors: Sterz
authors: Christoph
authors: C
authors: Weiser
authors: Wolfgang
authors: W
authors: Schreiber
authors: Alexander
authors: A
authors: Spiel
authors: Andreas
authors: A
authors: Schober
authors: Peter
authors: P
authors: Stratil
authors: Florian B
authors: FB
authors: Mayr
mesh_terms: D000328:Adult; D000368:Aged; D001317:Austria / Q000453:epidemiology; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012151:Resuscitation / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome