Department of Emergency Medicine and Integrative Biosciences Center, Wayne State University, Detroit, MI 48201, United States.
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
Resuscitation. 2023 Apr;185:109731. doi: 10.1016/j.resuscitation.2023.109731. Epub 2023 Feb 11.
To determine whether out-of-hospital cardiac arrest (OHCA) post-resuscitation management and outcomes differ between four Detroit hospitals.
Significant variation exists in treatment/outcomes from OHCA. Disparities between hospitals serving a similar population is not well known.
Retrospective OHCA data was collected from the Detroit-Cardiac Arrest Registry (DCAR) between January 2014 to December 2019. Four hospitals were compared on two treatments (angiography, do not resuscitate (DNR)) and two outcomes (cerebral performance category (CPC) ≤ 2, in-hospital death). Models for death and CPC were tested with and without coronary angiography and DNR status.
999 patients at hospitals A - D differed (p < 0.05) before multivariable adjustment by age, race, witnessed arrest, dispatch-emergency department (ED) time, TTM, coronary angiography, DNR order, and in-hospital death. Rates of death and CPC ≤ 2 were worse in Hospital A (82.8%, 10%, respectively) compared to others (69.1%, 14.1%). After multivariable adjustment, Hospital A performed angiography less compared to B (OR = 0.17) and was more likely to initiate new DNR status than B (OR = 2.9), C (OR = 16.1), or D (OR = 3.6). CPC ≤ 2 were worse in Hospital A compared to B (OR = 0.27) and D (OR = 0.35). After sensitivity analysis, CPC ≤ 2 odds did not differ for A versus B (OR = 0.58, adjusted for angiography) or D (OR = 0.65, adjusted for DNR). Odds of death, despite angiography and DNR differences, were worse in Hospital A compared to B (OR = 1.87) and D (OR = 1.81).
Differing rates of DNR and coronary angiography was associated with observed disparities in favorable neurologic outcome, but not death, between four Detroit hospitals.
确定四家底特律医院之间院外心脏骤停（OHCA）复苏后管理和结果是否存在差异。
OHCA 的治疗/结果存在显著差异。服务于类似人群的医院之间的差异尚不清楚。
从 2014 年 1 月至 2019 年 12 月，从底特律心脏骤停登记处（DCAR）收集了 OHCA 回顾性数据。对四家医院的两种治疗方法（血管造影术、不复苏（DNR））和两种结果（脑功能分类（CPC）≤2、院内死亡）进行了比较。在有和没有冠状动脉造影术和 DNR 状态的情况下，对死亡和 CPC 模型进行了测试。
在多变量调整之前，A-D 医院的 999 名患者在年龄、种族、目击性骤停、调度-急诊部（ED）时间、TTM、冠状动脉造影术、DNR 顺序和院内死亡方面存在差异（p<0.05）。与其他医院相比，医院 A 的死亡率（82.8%，10%）和 CPC≤2 的发生率（分别为 10%）更差。在多变量调整后，与 B 相比，A 医院进行血管造影术的可能性较小（OR=0.17），并且比 B（OR=2.9）、C（OR=16.1）或 D（OR=3.6）更有可能开始新的 DNR 状态。与 B（OR=0.27）和 D（OR=0.35）相比，A 医院的 CPC≤2 结果更差。在敏感性分析中，尽管存在血管造影术和 DNR 差异，但 A 与 B（OR=0.58，调整血管造影术）或 D（OR=0.65，调整 DNR）的 CPC≤2 几率无差异。与 B（OR=1.87）和 D（OR=1.81）相比，尽管进行了血管造影术和 DNR 治疗，但 A 医院的死亡率更高。
DNR 和冠状动脉造影术的不同比率与四家底特律医院之间观察到的有利神经结果差异相关，但与死亡无关。
