Critical Care/Resuscitation
Abstracts
Background: Current guidelines endorse regionalized cardiac resuscitation centers (CRC) to deliver comprehensive post-cardiac arrest (CA) care. We deployed a standardized post-CA clinical pathway and quality improvement (QI) process within our 35-hospital regional healthcare system in 2014. We sought to determine the impact of the post-CA clinical pathway on outcomes at five CRCs.
Methods: Retrospective analysis of our post-cardiac arrest registry of adult CA patients was performed comparing outcomes at 5 CRCs from July 1, 2014 to December 31, 2018. The registry utilizes a standardized data dictionary with explicitly defined variables. During the months prior to the study period, the hospital system deployed standardized post-arrest clinical pathways, education, QI process, and quarterly system-wide collaborative conference calls. The primary outcome was good neurological outcome at hospital discharge, defined as Pittsburgh cerebral performance category (CPC) 1-2.
Results: Of 1764 post-arrest patients during the study period, 1740 (98.6%) were included for analysis (Hospital A: 37.6% (n=655); B: 20.7% (n=361); C: 19.8% (n=344); D: 12.1% (n=212); E: 9.7% (n=168). Overall, median age was 61 (IQR 51-71) years, 1086 (62%) were male, 1549 (89%) were out of hospital cardiac arrests (OHCAs), 1329 (76%) had a witnessed arrest, and 765 (44%) with an initial shockable rhythm. An initial shockable rhythm was observed as follows: A: 44.9% (n=294); B: 53.4% (n=193); C: 39.2% (n=135); D 46.7% (n=99); E: 26.2% (n=44). There was a significant difference in good neurologic outcome between the five hospitals [A: 18.5% (n=121); B: 32.4% (n=117); C: 25.0% (n=86); D: 35.4% (n=75); E: 19.6% (n=33), p < 0.0001)]. However, for witnessed shockable OHCA (33.8%, n=588), there was no difference in good neurologic outcome between the 5 facilities [A: 54.5% (n=126); B: 50.9% (n=77); C: 44.6% (n=45); D: 48.6% (n=36); E: 45.0% (n=14), p=0.49)].
Conclusion: This single hospital system study revealed differences in outcomes amongst 5 CRCs utilizing a standardized post-cardiac arrest clinical pathway. However, when the subset of witnessed shockable OHCA patients were analyzed, there was no difference in outcomes. This suggests that differences in cardiac arrest characteristics among patients enrolled across the 5 CRCs may explain the differences observed in overall outcomes.