title: Association between treatment at an ST-segment elevation myocardial infarction center and neurologic recovery after out-of-hospital cardiac arrest.
abstract: BACKGROUND
  For patients resuscitated from out-of-hospital cardiac arrest (OHCA), the American Heart Association recommends regionalized care at cardiac resuscitation centers that are aligned with ST-segment elevation myocardial infarction (STEMI) centers. The effectiveness of treatment at STEMI centers remains unknown.
  
  
  OBJECTIVE
  To evaluate whether good neurologic recovery after OHCA is associated with treatment at an STEMI center and if volume of admitted OHCA patients is associated with good neurologic recovery.
  
  
  METHODS
  We included patients in the 2011 California Office of Statewide Health Planning and Development database with a "present on admission" diagnosis of cardiac arrest. Primary outcome was good neurologic recovery at hospital discharge. Hierarchical multiple logistic regression models were used to determine the association between treating hospital and good neurologic recovery after adjusting for patient factors (age, sex, race, ethnicity, insurance type, and ventricular arrest rhythm) and hospital factors (hospital size, intensive care unit bed days, trauma center designation, and teaching status).
  
  
  RESULTS
  We included 7,725 patients; two-thirds (5,202) were treated at an STEMI center and 1,869 (24%, 95% CI 23%-25%) had good neurologic recovery. After adjustment, treatment at an STEMI center with ≥40 and <40 OHCA cases/year were associated with good neurologic recovery (odds ratio 1.32 [95% CI 1.06-1.64] and 1.63 [95% CI 1.35-1.97], respectively). Higher volume of admitted OHCA patients was associated with decreased odds of good neurologic recovery (adjusted odds ratio per 10 patients 0.96, 95% CI 0.92-1.00), but this association was not statistically significant after excluding the highest-volume outlier.
  
  
  CONCLUSIONS
  Treatment at an STEMI center-regardless of its annual OHCA volume-after resuscitation from OHCA is associated with good neurologic recovery. Regionalized systems of care should prioritize STEMI centers as destinations for resuscitated OHCA patients.
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA. Electronic address: bemumma@ucdavis.edu.
authors.forename: Bryn E
authors.initials: BE
authors.lastname: Mumma
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA.
authors.forename: Deborah B
authors.initials: DB
authors.lastname: Diercks
authors.affiliation: Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA.
authors.forename: Machelle D
authors.initials: MD
authors.lastname: Wilson
authors.affiliation: Department of Emergency Medicine, University of California Davis School of Medicine, Sacramento, CA.
authors.forename: James F
authors.initials: JF
authors.lastname: Holmes
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology*; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications*; D020127:Recovery of Function; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology