Association between hospital post-resuscitative performance and clinical outcomes after out-of-hospital cardiac arrest.
BACKGROUND
Survival varies among those resuscitated from out-of-hospital cardiac arrest (OHCA). Evidence-based performance measures have been used to describe hospital quality of care in conditions such as acute coronary syndrome and major trauma. It remains unclear if adherence to performance measures is associated with better outcome in patients hospitalized after OHCA.


OBJECTIVE
To assess whether a composite performance score based on evidence-based guidelines for care of patients resuscitated from OHCA was independently associated with clinical outcomes.


METHODS
Included were 3252 patients with OHCA who received care at 111 U.S. and Canadian hospitals participating in the Resuscitation Outcomes Consortium (ROC-PRIMED) study between June 2007 and October 2009. We calculated composite performance scores for all patients, aggregated these at the hospital level, then associated them with patient mortality and favorable neurological status at discharge.


RESULTS
Composite performance scores varied widely (median [IQR] scores from lowest to highest hospital quartiles, 21% [20%, 25%] vs. 59% [55%, 64%]. Adjusted survival to discharge increased with each quartile of performance score (from lowest to highest: 16.2%, 20.8%, 28.5%, 34.8%, P<0.01), with similar findings for adjusted rates of good neurologic status. Hospital score was significantly associated with outcome after risk adjustment for established baseline factors (highest vs. lowest adherence quartile: adjusted OR of survival 1.64; 95% CI 1.13, 2.38).


CONCLUSIONS
Greater survival and favorable neurologic status at discharge were associated with greater adherence to recommended hospital based post-resuscitative care guidelines. Consideration should be given to measuring, reporting and improving hospital adherence to guideline-based performance measures, which could improve outcomes following OHCA.
University of Washington, Seattle, WA, United States; Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia; St Paul's Hospital University of British Columbia, Vancouver, BC, Canada; Alfred Hospital Melbourne, Australia.
Dion
D
Stub
University of Washington, Seattle, WA, United States.
Robert H
RH
Schmicker
Duke University, Durham, NC, United States.
Monique L
ML
Anderson
University of Pittsburgh, Pittsburgh, PA, United States.
Clifton W
CW
Callaway
Oregon Health and Science University, Portland, OR, United States.
Mohamud R
MR
Daya
University of Washington, Seattle, WA, United States.
Michael R
MR
Sayre
University of Pittsburgh, Pittsburgh, PA, United States.
Jonathan
J
Elmer
St Paul's Hospital University of British Columbia, Vancouver, BC, Canada.
Brian E
BE
Grunau
Medical College of Wisconsin, Milwaukee, WI, United States.
Tom P
TP
Aufderheide
University of Toronto, Toronto, ON, Canada.
Steve
S
Lin
University of Toronto, Toronto, ON, Canada.
Jason E
JE
Buick
Oregon Health and Science University, Portland, OR, United States.
Dana
D
Zive
Duke University, Durham, NC, United States.
Eric D
ED
Peterson
University of Washington, Seattle, WA, United States. Electronic address: nichol@uw.edu.
Graham
G
Nichol
D002170:Canada / Q000453:epidemiology; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004632:Emergency Medical Services / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000628:therapy*; D011785:Quality Assurance, Health Care; D012042:Registries; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
Cardiac arrest; Performance score; Post resuscitation care; Resuscitation