title: Hospital characteristics and favourable neurological outcome among patients with out-of-hospital cardiac arrest in Osaka, Japan.
abstract: To assess the association between favourable neurological outcome and hospital characteristics such as hospital volume and number of critical care centres (CCMCs) after out-of-hospital cardiac arrest (OHCA).
  
  
  
  This retrospective, population-based observational study conducted in Osaka Prefecture, Japan included adult patients with OHCA, aged ≥18 years who were transported to acute care hospitals between January 2005 and December 2012. We divided acute care hospitals into CCMCs or non-CCMCs, the latter of which were divided into the following three groups according to the annual average number of transported OHCA cases: low-volume (≤10 cases), middle-volume (11-39 cases), and high-volume (≥40 cases) groups. Random effects logistic regression models, with hospital treated as a random effect, were used to assess factors potentially associated with a favourable neurological outcome.
  
  
  
  A total of 44,474 patients were eligible. The proportions of favourable neurological outcome from OHCA were 0.9% (31/3559) in the low-volume group, 1.2% (106/9171) in the middle-volume group, 1.6% (222/14,007) in the high-volume group, and 4.3% (766/17,737) in the CCMC group (P<0.001). In the multivariable analysis, transport to CCMCs was significantly associated with favourable neurological outcome, compared with transport to non-CCMCs (adjusted odds ratio 1.63; 95% confidence interval, 1.60-1.66). Among the non-CCMC group, there was no significant relationship between hospital volume and favourable neurological outcome.
  
  
  
  In this population, transport of OHCA patients to CCMCs led to significantly higher one-month survival rates with favourable neurological outcome from OHCA, whereas no significant association was noted among the hospitals with different volumes.
authors.affiliation: Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Tasuku
authors.initials: T
authors.lastname: Matsuyama
authors.affiliation: Department of Public Health, Tokyo Women's Medical University, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kiyohara
authors.affiliation: Division of Environmental Medicine and Population Sciences, Department of Social and Environmental Medicine, Graduate School of Medicine, Osaka University, 2-5 Yamada-oka, Suita, Osaka 565-0871, Japan. Electronic address: lucky_unatan@yahoo.co.jp.
authors.forename: Tetsuhisa
authors.initials: T
authors.lastname: Kitamura
authors.affiliation: Department of Critical Care Nursing, Kyoto University Graduate School of Human Health Science, Kyoto, Japan.
authors.forename: Chika
authors.initials: C
authors.lastname: Nishiyama
authors.affiliation: Department of Acute Medicine, Kindai University Faculty of Medicine, Osaka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Nishiuchi
authors.affiliation: Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, Osaka, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Hayashi
authors.affiliation: Kyoto University Health Services, Kyoto, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.affiliation: Department of Emergency Medicine, Kyoto Prefectural University of Medicine, Kyoto, Japan.
authors.forename: Bon
authors.initials: B
authors.lastname: Ohta
authors.affiliation: Kyoto University Health Services, Kyoto, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Iwami
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006761:Hospitals / Q000145:classification / Q000706:statistics & numerical data; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology / Q000517:prevention & control; D058687:Out-of-Hospital Cardiac Arrest / Q000150:complications / Q000401:mortality / Q000628:therapy; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D012189:Retrospective Studies; D015996:Survival Rate; D014187:Transportation of Patients / Q000379:methods / Q000706:statistics & numerical data
keywords: Cardiopulmonary resuscitation; Critical care medical centre; Hospital characteristics; Hospital volume; Out-of-hospital cardiac arrest