Department of Public Health, Erasmus University Medical Center, Postbus, 3000 CA, Rotterdam, The Netherlands.
Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Crit Care. 2021 Sep 10;25(1):329. doi: 10.1186/s13054-021-03754-8.
Survival after in-hospital cardiac arrest is poor, but current literature shows substantial heterogeneity in reported survival rates. This study aims to evaluate care for patients suffering in-hospital cardiac arrest (IHCA) in the Netherlands by assessing between-hospital heterogeneity in outcomes and to explain this heterogeneity stemming from differences in case-mix or differences in quality of care.
A prospective multicentre study was conducted comprising 14 centres. All IHCA patients were included. The adjusted variation in structure and process indicators of quality of care and outcomes (in-hospital mortality and cerebral performance category [CPC] scale) was assessed with mixed effects regression with centre as random intercept. Variation was quantified using the median odds ratio (MOR), representing the expected odds ratio for poor outcome between two randomly picked centres.
After excluding centres with less than 10 inclusions (2 centres), 701 patients were included of whom, 218 (32%) survived to hospital discharge. The unadjusted and case-mix adjusted MOR for mortality was 1.19 and 1.05, respectively. The unadjusted and adjusted MOR for CPC score was 1.24 and 1.19, respectively. In hospitals where personnel received cardiopulmonary resuscitation (CPR) training twice per year, 183 (64.7%) versus 290 (71.4%) patients died or were in a vegetative state, and 59 (20.8%) versus 68 (16.7%) patients showed full recovery (p < 0.001).
In the Netherlands, survival after IHCA is relatively high and between-centre differences in outcomes are small. The existing differences in survival are mainly attributable to differences in case-mix. Variation in neurological outcome is less attributable to case-mix.
院内心脏骤停患者的存活率较低，但目前的文献表明，报告的存活率存在很大差异。本研究旨在通过评估医院间结局的异质性，评估荷兰院内心脏骤停（IHCA）患者的治疗情况，并解释这种异质性源自病例组合的差异或护理质量的差异。
本研究为前瞻性多中心研究，纳入了 14 个中心的所有 IHCA 患者。采用混合效应回归模型，以中心为随机截距，评估了结构和过程质量指标以及结局（院内死亡率和脑功能分类[CPC]量表）的医院间差异。采用中位数优势比（MOR）来量化变异，代表两个随机抽取的中心之间不良结局的预期优势比。
排除了纳入病例少于 10 例的中心（2 个）后，共纳入 701 例患者，其中 218 例（32%）存活至出院。死亡率的未调整和病例组合调整后的 MOR 分别为 1.19 和 1.05。CPC 评分的未调整和调整后的 MOR 分别为 1.24 和 1.19。在每年接受心肺复苏（CPR）培训两次的医院中，183 例（64.7%）患者死亡或处于植物人状态，而 290 例（71.4%）患者死亡或处于植物人状态，59 例（20.8%）患者完全康复，而 68 例（16.7%）患者完全康复（p<0.001）。
在荷兰，IHCA 后的存活率相对较高，且医院间结局的差异较小。目前存活率的差异主要归因于病例组合的差异。神经结局的差异较少归因于病例组合。
