Department of Emergency Medicine, Hokkaido University Hospital, N14W5 Kita-ku, Sapporo, 060-8648, Japan.
Ono Biostat Consulting, Narita-higashi, Suginami-ku, Tokyo, 166-0015, Japan.
BMC Emerg Med. 2022 Jul 7;22(1):121. doi: 10.1186/s12873-022-00685-7.
Although the prognosis of patients treated at specialized facilities has improved, the relationship between the number of patients treated at hospitals and prognosis is controversial and lacks constancy in those with out-of-hospital cardiac arrest (OHCA). This study aimed to clarify the effect of annual hospital admissions on the prognosis of adult patients with OHCA by analyzing a large cohort.
The effect of annual hospital admissions on patient prognosis was analyzed retrospectively using data from the Japanese Association for Acute Medicine OHCA registry, a nationwide multihospital prospective database. This study analyzed 3632 of 35,754 patients hospitalized for OHCA of cardiac origin at 86 hospitals. The hospitals were divided into tertiles based on the volume of annual admissions. The effect of hospital volume on prognosis was analyzed using logistic regression analysis with multiple imputation. Furthermore, three subgroup analyses were performed for patients with return of spontaneous circulation (ROSC) before arrival at the emergency department, patients admitted to critical care medical centers, and patients admitted to extracorporeal membrane oxygenation-capable hospitals.
Favorable neurological outcomes 30 days after OHCA for patients overall showed no advantage for medium- and high-volume centers over low-volume centers; Odds ratio (OR) 0.989, (95% Confidence interval [CI] 0.562-1.741), OR 1.504 (95% CI 0.919-2.463), respectively. However, the frequency of favorable neurological outcomes in OHCA patients with ROSC before arrival at the emergency department at high-volume centers was higher than those at low-volume centers (OR 1.955, 95% CI 1.033-3.851).
Hospital volume did not significantly affect the prognosis of adult patients with OHCA. However, transport to a high-volume hospital may improve the neurological prognosis in OHCA patients with ROSC before arrival at the emergency department.
尽管在专科医院接受治疗的患者预后有所改善，但医院治疗患者数量与预后之间的关系存在争议，且在院外心脏骤停（OHCA）患者中缺乏一致性。本研究旨在通过分析大样本队列来阐明年度住院人数对 OHCA 成年患者预后的影响。
本研究使用日本急救医学会 OHCA 注册登记处的全国多医院前瞻性数据库中的数据，对 86 家医院因心源性 OHCA 住院的 35754 例患者中的 3632 例进行回顾性分析。根据年度入院人数将医院分为三分位。采用多变量逻辑回归分析和多重插补法分析医院容量对预后的影响。此外，还对到达急诊科前出现自主循环恢复（ROSC）、入住重症监护医学中心和入住体外膜肺氧合（ECMO）能力医院的患者进行了 3 项亚组分析。
总体而言，OHCA 后 30 天患者的良好神经功能结局并未显示中高容量中心比低容量中心具有优势；OR 值分别为 0.989（95%CI 0.562-1.741）和 1.504（95%CI 0.919-2.463）。然而，在到达急诊科前已出现 ROSC 的 OHCA 患者中，高容量中心的良好神经功能结局频率高于低容量中心（OR 1.955，95%CI 1.033-3.851）。
医院容量对 OHCA 成年患者的预后无显著影响。然而，将患者转运至高容量医院可能会改善到达急诊科前已出现 ROSC 的 OHCA 患者的神经预后。
