Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology

Michael T. Cudnik, Comilla Sasson, Thomas D. Rea, Michael R. Sayre, Jianying Zhang, Bentley J. Bobrow, Daniel W. Spaite, Bryan McNally, Kurt Denninghoff, Uwe Stolz, Mike Levy, Joseph Barger, James V. Dunford, Karl Sporer, Angelo Salvucci, David Ross, Christopher Colwell, Dorothy Turnbull, Rob Rosenbaum, Kathleen SchrankMark Waterman, Richard Dukes, Melissa Lewis, Raymond Fowler, John Lloyd, Art Yancey, Earl Grubbs, John Lloyd, Johnathan Morris, Stephen Boyle, Troy Johnson, Christopher Wizner, Melissa White, Sabina Braithwaite, Sophia Dyer, Gary Setnik, Bob Hassett, John Santor, Bob Swor, Todd Chassee, Charlie Lick, Mike Parrish, Darel Radde, Brian Mahoney, Darell Todd, Joseph Salomone, Eric Ossman, Brent Myers, Lee Garvey, James Camerson, David Slattery, Joseph Ryan, Jason McMullan, David Keseg, James Leaming, B. K. Sherwood, Jeff Luther, Corey Slovis, Paul Hinchey, Michael Harrington, John Griswell, Jeff Beeson, David Persse, Mark Gamber, Joe Ornato

Research output: Contribution to journalArticle

51 Citations (Scopus)

Abstract

Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI95 0.83-1.28) among 11-39 annual volume and 0.97 (CI95 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.

Original languageEnglish (US)
Pages (from-to)862-868
Number of pages7
JournalResuscitation
Volume83
Issue number7
DOIs
StatePublished - Jul 2012

Fingerprint

Out-of-Hospital Cardiac Arrest
Survival
Ventricular Fibrillation
Ventricular Tachycardia
Resuscitation
American Hospital Association
Cardiac Volume

Keywords

  • Health outcomes
  • Out of hospital cardiac arrest
  • Resuscitation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Emergency
  • Emergency Medicine

Cite this

Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology. / Cudnik, Michael T.; Sasson, Comilla; Rea, Thomas D.; Sayre, Michael R.; Zhang, Jianying; Bobrow, Bentley J.; Spaite, Daniel W.; McNally, Bryan; Denninghoff, Kurt; Stolz, Uwe; Levy, Mike; Barger, Joseph; Dunford, James V.; Sporer, Karl; Salvucci, Angelo; Ross, David; Colwell, Christopher; Turnbull, Dorothy; Rosenbaum, Rob; Schrank, Kathleen; Waterman, Mark; Dukes, Richard; Lewis, Melissa; Fowler, Raymond; Lloyd, John; Yancey, Art; Grubbs, Earl; Lloyd, John; Morris, Johnathan; Boyle, Stephen; Johnson, Troy; Wizner, Christopher; White, Melissa; Braithwaite, Sabina; Dyer, Sophia; Setnik, Gary; Hassett, Bob; Santor, John; Swor, Bob; Chassee, Todd; Lick, Charlie; Parrish, Mike; Radde, Darel; Mahoney, Brian; Todd, Darell; Salomone, Joseph; Ossman, Eric; Myers, Brent; Garvey, Lee; Camerson, James; Slattery, David; Ryan, Joseph; McMullan, Jason; Keseg, David; Leaming, James; Sherwood, B. K.; Luther, Jeff; Slovis, Corey; Hinchey, Paul; Harrington, Michael; Griswell, John; Beeson, Jeff; Persse, David; Gamber, Mark; Ornato, Joe.

In: Resuscitation, Vol. 83, No. 7, 07.2012, p. 862-868.

Research output: Contribution to journalArticle

Cudnik, MT, Sasson, C, Rea, TD, Sayre, MR, Zhang, J, Bobrow, BJ, Spaite, DW, McNally, B, Denninghoff, K, Stolz, U, Levy, M, Barger, J, Dunford, JV, Sporer, K, Salvucci, A, Ross, D, Colwell, C, Turnbull, D, Rosenbaum, R, Schrank, K, Waterman, M, Dukes, R, Lewis, M, Fowler, R, Lloyd, J, Yancey, A, Grubbs, E, Lloyd, J, Morris, J, Boyle, S, Johnson, T, Wizner, C, White, M, Braithwaite, S, Dyer, S, Setnik, G, Hassett, B, Santor, J, Swor, B, Chassee, T, Lick, C, Parrish, M, Radde, D, Mahoney, B, Todd, D, Salomone, J, Ossman, E, Myers, B, Garvey, L, Camerson, J, Slattery, D, Ryan, J, McMullan, J, Keseg, D, Leaming, J, Sherwood, BK, Luther, J, Slovis, C, Hinchey, P, Harrington, M, Griswell, J, Beeson, J, Persse, D, Gamber, M & Ornato, J 2012, 'Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology', Resuscitation, vol. 83, no. 7, pp. 862-868. https://doi.org/10.1016/j.resuscitation.2012.02.006
Cudnik, Michael T. ; Sasson, Comilla ; Rea, Thomas D. ; Sayre, Michael R. ; Zhang, Jianying ; Bobrow, Bentley J. ; Spaite, Daniel W. ; McNally, Bryan ; Denninghoff, Kurt ; Stolz, Uwe ; Levy, Mike ; Barger, Joseph ; Dunford, James V. ; Sporer, Karl ; Salvucci, Angelo ; Ross, David ; Colwell, Christopher ; Turnbull, Dorothy ; Rosenbaum, Rob ; Schrank, Kathleen ; Waterman, Mark ; Dukes, Richard ; Lewis, Melissa ; Fowler, Raymond ; Lloyd, John ; Yancey, Art ; Grubbs, Earl ; Lloyd, John ; Morris, Johnathan ; Boyle, Stephen ; Johnson, Troy ; Wizner, Christopher ; White, Melissa ; Braithwaite, Sabina ; Dyer, Sophia ; Setnik, Gary ; Hassett, Bob ; Santor, John ; Swor, Bob ; Chassee, Todd ; Lick, Charlie ; Parrish, Mike ; Radde, Darel ; Mahoney, Brian ; Todd, Darell ; Salomone, Joseph ; Ossman, Eric ; Myers, Brent ; Garvey, Lee ; Camerson, James ; Slattery, David ; Ryan, Joseph ; McMullan, Jason ; Keseg, David ; Leaming, James ; Sherwood, B. K. ; Luther, Jeff ; Slovis, Corey ; Hinchey, Paul ; Harrington, Michael ; Griswell, John ; Beeson, Jeff ; Persse, David ; Gamber, Mark ; Ornato, Joe. / Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology. In: Resuscitation. 2012 ; Vol. 83, No. 7. pp. 862-868.
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abstract = "Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35{\%} among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100{\%}). Unadjusted survival did not differ between the 3 hospital groups (36{\%} for ≤10 OHCA/year, 35{\%} for 11-39, and 36{\%} for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI95 0.83-1.28) among 11-39 annual volume and 0.97 (CI95 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.",
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author = "Cudnik, {Michael T.} and Comilla Sasson and Rea, {Thomas D.} and Sayre, {Michael R.} and Jianying Zhang and Bobrow, {Bentley J.} and Spaite, {Daniel W.} and Bryan McNally and Kurt Denninghoff and Uwe Stolz and Mike Levy and Joseph Barger and Dunford, {James V.} and Karl Sporer and Angelo Salvucci and David Ross and Christopher Colwell and Dorothy Turnbull and Rob Rosenbaum and Kathleen Schrank and Mark Waterman and Richard Dukes and Melissa Lewis and Raymond Fowler and John Lloyd and Art Yancey and Earl Grubbs and John Lloyd and Johnathan Morris and Stephen Boyle and Troy Johnson and Christopher Wizner and Melissa White and Sabina Braithwaite and Sophia Dyer and Gary Setnik and Bob Hassett and John Santor and Bob Swor and Todd Chassee and Charlie Lick and Mike Parrish and Darel Radde and Brian Mahoney and Darell Todd and Joseph Salomone and Eric Ossman and Brent Myers and Lee Garvey and James Camerson and David Slattery and Joseph Ryan and Jason McMullan and David Keseg and James Leaming and Sherwood, {B. K.} and Jeff Luther and Corey Slovis and Paul Hinchey and Michael Harrington and John Griswell and Jeff Beeson and David Persse and Mark Gamber and Joe Ornato",
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TY - JOUR

T1 - Increasing hospital volume is not associated with improved survival in out of hospital cardiac arrest of cardiac etiology

AU - Cudnik, Michael T.

AU - Sasson, Comilla

AU - Rea, Thomas D.

AU - Sayre, Michael R.

AU - Zhang, Jianying

AU - Bobrow, Bentley J.

AU - Spaite, Daniel W.

AU - McNally, Bryan

AU - Denninghoff, Kurt

AU - Stolz, Uwe

AU - Levy, Mike

AU - Barger, Joseph

AU - Dunford, James V.

AU - Sporer, Karl

AU - Salvucci, Angelo

AU - Ross, David

AU - Colwell, Christopher

AU - Turnbull, Dorothy

AU - Rosenbaum, Rob

AU - Schrank, Kathleen

AU - Waterman, Mark

AU - Dukes, Richard

AU - Lewis, Melissa

AU - Fowler, Raymond

AU - Lloyd, John

AU - Yancey, Art

AU - Grubbs, Earl

AU - Lloyd, John

AU - Morris, Johnathan

AU - Boyle, Stephen

AU - Johnson, Troy

AU - Wizner, Christopher

AU - White, Melissa

AU - Braithwaite, Sabina

AU - Dyer, Sophia

AU - Setnik, Gary

AU - Hassett, Bob

AU - Santor, John

AU - Swor, Bob

AU - Chassee, Todd

AU - Lick, Charlie

AU - Parrish, Mike

AU - Radde, Darel

AU - Mahoney, Brian

AU - Todd, Darell

AU - Salomone, Joseph

AU - Ossman, Eric

AU - Myers, Brent

AU - Garvey, Lee

AU - Camerson, James

AU - Slattery, David

AU - Ryan, Joseph

AU - McMullan, Jason

AU - Keseg, David

AU - Leaming, James

AU - Sherwood, B. K.

AU - Luther, Jeff

AU - Slovis, Corey

AU - Hinchey, Paul

AU - Harrington, Michael

AU - Griswell, John

AU - Beeson, Jeff

AU - Persse, David

AU - Gamber, Mark

AU - Ornato, Joe

PY - 2012/7

Y1 - 2012/7

N2 - Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI95 0.83-1.28) among 11-39 annual volume and 0.97 (CI95 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.

AB - Background: Resuscitation centers may improve patient outcomes by achieving sufficient experience in post-resuscitation care. We analyzed the relationship between survival and hospital volume among patients suffering out-of-hospital cardiac arrest (OHCA). Methods: This prospective cohort investigation collected data from the Cardiac Arrest Registry to Enhance Survival database from 10/1/05 to 12/31/09. Primary outcome was survival to discharge. Hospital characteristics were obtained via 2005 American Hospital Association Survey. A hospital's use of hypothermia was obtained via direct survey. To adjust for hospital- and patient-level variation, multilevel, hierarchical logistic regression was performed. Hospital volume was modeled as a categorical (OHCA/year. ≤. 10, 11-39, ≥40) variable. A stratified analysis evaluating those with ventricular fibrillation or pulseless ventricular tachycardia (VF/VT) was also performed. Results: The cohort included 4125 patients transported by EMS to 155 hospitals in 16 states. Overall survival to hospital discharge was 35% among those admitted to the hospital. Individual hospital rates of survival varied widely (0-100%). Unadjusted survival did not differ between the 3 hospital groups (36% for ≤10 OHCA/year, 35% for 11-39, and 36% for ≥40; p=0.75). After multilevel adjustment, differences in survival across the groups were not statistically significant. Compared to patients at hospitals with ≤10 OHCA/year, adjusted OR for survival was 1.04 (CI95 0.83-1.28) among 11-39 annual volume and 0.97 (CI95 0.73-1.30) among the ≥40 volume hospitals. Among patients presenting with VF/VT, no difference in survival was identified between the hospital groups. Conclusion: Survival varied substantially across hospitals. However, hospital OHCA volume was not associated with likelihood of survival. Additional efforts are required to determine what hospital characteristics might account for the variability observed in OHCA hospital outcomes.

KW - Health outcomes

KW - Out of hospital cardiac arrest

KW - Resuscitation

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