[Differences between hospitals in prognosis after resuscitated out-of-hospital cardiac arrest patients].

INTRODUCTION

There are substantial differences in long-term survival of patients resuscitated from out-of-hospital cardiac arrest, and the level of care during hospitalization may be a contributing factor. The purpose of this study was to determine if a difference in long-term prognosis between hospitals could be detected in patients surviving cardiac arrest in Copenhagen.

MATERIAL AND METHODS

The mobile emergency care unit attempted resuscitation in 1,098 patients with out-of-hospital cardiac arrest in the period 2002 to 2006, among whom return of spontaneous circulation occurred in 336 (30%) of the patients admitted to hospital. Survival was determined using the Central Population Registry through Statistics Denmark.

RESULTS

Patients admitted to a tertiary facility were younger, more frequently male, they had more commonly ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) as their initial rhythm, and they had more frequently received bystander cardiopulmonary resuscitation. Survival at 4.6 years was 41% in patients admitted to the tertiary hospital and 10% in patients admitted to other hospitals, p < 0.0001. After adjustment for other known risk factors, patients admitted to other hospitals had a hazard ratio of 1.8 for death (95% confidence interval: 1,4-2,5) compared with patients admitted to a tertiary facility.

CONCLUSION

The survival rate after out-of-hospital cardiac arrest was significantly higher in patients admitted to a tertiary facility than among patients admitted to less specialized hospitals. Further studies are needed to identify causal factors.