Elmer Jonathan, Rittenberger Jon C, Coppler Patrick J, Guyette Francis X, Doshi Ankur A, Callaway Clifton W
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh PA, United States; Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh PA, United States.
Department of Emergency Medicine, University of Pittsburgh, Pittsburgh PA, United States.
Resuscitation. 2016 Nov;108:48-53. doi: 10.1016/j.resuscitation.2016.09.008. Epub 2016 Sep 17.
The Institute of Medicine and American Heart Association have called for tiered accreditation standards and regionalization of post-cardiac arrest care, but there is little data to support that regionalization has a durable effect on patient outcomes. We tested the effect of treatment at a high-volume center on long-term outcome after sudden cardiac arrest (SCA).
We included patients hospitalized at one of 7 medical centers in Southwestern Pennsylvania after SCA from 2005 to 2013. Centers were one regional referral center with an organized systems for post-SCA care, two moderate volume tertiary care centers and 4 low-volume centers. We abstracted clinical characteristics and outcomes at hospital discharge, and for survivors to discharge we queried the National Death Index for long-term survival data. We used Cox regression to determine the unadjusted associations of baseline predictors and survival, and built an adjusted model controlling for baseline predictors.
Overall, 987 patients survived to discharge. During 2196 person-years of follow-up, median survival was 5.3 years and there were 396 deaths. In unadjusted analysis, treating center, age, arrest location, Charlson Comorbidity Index, initial rhythm, cardiac catheterization, defibrillator placement, discharge disposition, and neurological status at discharge were associated with long-term outcome. In adjusted analysis, treatment at the high-volume cardiac arrest center was associated with improved survival compared to treatment at other centers (hazards ratio 1.49, 95% confidence interval 1.19-1.86).
Treatment at a high-volume cardiac arrest center with organized systems for post-arrest care is associated with a substantial long-term survival benefit after hospital discharge.
美国医学研究所和美国心脏协会呼吁制定分级认证标准并实现心脏骤停后护理的区域化，但几乎没有数据支持区域化对患者预后有持久影响。我们测试了在高容量中心进行治疗对心脏骤停（SCA）后长期预后的影响。
我们纳入了2005年至2013年在宾夕法尼亚州西南部7个医疗中心之一住院的SCA患者。这些中心包括一个设有心脏骤停后护理组织系统的区域转诊中心、两个中等容量的三级护理中心和4个低容量中心。我们提取了出院时的临床特征和预后信息，对于存活至出院的患者，我们查询了国家死亡指数以获取长期生存数据。我们使用Cox回归来确定基线预测因素与生存的未调整关联，并构建了一个控制基线预测因素的调整模型。
总体而言，987名患者存活至出院。在2196人年的随访期间，中位生存期为5.3年，有396人死亡。在未调整分析中，治疗中心、年龄、骤停地点、Charlson合并症指数、初始心律、心脏导管插入术、除颤器植入、出院处置以及出院时的神经状态与长期预后相关。在调整分析中，与其他中心相比，在高容量心脏骤停中心接受治疗与生存率提高相关（风险比1.49，95%置信区间1.19 - 1.86）。
在设有心脏骤停后护理组织系统的高容量心脏骤停中心接受治疗与出院后显著的长期生存获益相关。
