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Hospital variability of out-of-hospital cardiac arrest survival. Prehosp Emerg Care 2008;12(3):339-46

Date

06/28/2008

Pubmed ID

18584502

DOI

10.1080/10903120802101330

Scopus ID

2-s2.0-46349084488 (requires institutional sign-in at Scopus site)   54 Citations

Abstract

BACKGROUND: Previous literature has identified patient and emergency medical services (EMS) system factors that are associated with survival of out-of-hospital cardiac arrest patients.

OBJECTIVE: To determine variability in rates of survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients and to identify hospital-related factors associated with survival.

METHODS: This was a retrospective, observational study of all adult (21 years or older) out-of-hospital Utstein criteria cardiac-etiology arrests treated by Milwaukee County EMS during the period 1995-2005 and surviving to hospital intensive care unit admission. The primary outcome measure was survival to hospital discharge. Logistic regression analysis was used to compare the odds of survival between hospitals, patient factors, and hospital factors.

RESULTS: 1,702 patients at eight receiving hospitals were included in the study analyses. Hospital survival rates ranged from 29% to 42%. Patient and case factors associated with increased survival included younger age, male gender, nonwhite race, witnessed arrest in a public location, bystander cardiopulmonary resuscitation (CPR), a modest number of defibrillations, and initial cardiac rhythm of ventricular tachycardia. The only hospital characteristic correlated with survival was the number of beds per nurse. Patients admitted to a hospital with a ratio of beds to nurse less than 1.0 were over 1.5 times more likely to survive.

CONCLUSIONS: Survival to discharge of resuscitated adult out-of-hospital cardiac arrest patients may vary by receiving hospital. A hospital's ratio of beds to nurse and several patient/case f actors are correlated with survival. Further research is warranted to investigate how this may affect resuscitation care, EMS transport policy, and research design.

Author List

Liu JM, Yang Q, Pirrallo RG, Klein JP, Aufderheide TP

Authors

Tom P. Aufderheide MD Professor in the Emergency Medicine department at Medical College of Wisconsin
Jason M. Liu MD Professor in the Emergency Medicine department at Medical College of Wisconsin




MESH terms used to index this publication - Major topics in bold

Adult
Cardiopulmonary Resuscitation
Emergency Service, Hospital
Female
Heart Arrest
Hospital Bed Capacity
Hospital Mortality
Humans
Male
Middle Aged
Multivariate Analysis
Personnel Staffing and Scheduling
Retrospective Studies
Survival Rate
Transportation of Patients
Wisconsin